PG-13 Life Readiness Program Registration & Interest Form Thank you for your interest in PG-13. Please complete this form to register or learn more about our program. Full Name Date of Birth Age Email Address Phone Number Address City State Zip Code Parent/Guardian Name (if under 18) Parent/Guardian Phone Parent/Guardian Email Current Status Select one High School Senior Recent Graduate College Student Working Other Preferred Cohort Select one Summer Cohort Fall Cohort Winter Cohort Spring Cohort Preferred Format Select one In-Person Virtual Hybrid Areas of Interest Resume Building Job Readiness Financial Literacy College Planning Trade Careers Life Skills Public Speaking Professional Etiquette Interview Skills Digital Presence / Social Media Clean-Up What are your goals for joining PG-13? Emergency Contact Name Emergency Contact Relationship Emergency Contact Phone Medical, Accessibility, or Special Considerations Media Release Yes, I give permission for PG-13 to use photos/videos for promotional purposes No, I do not give permission Agreement I am interested in registering for PG-13. I understand payment, if applicable, will be submitted later. I understand this form is for registration and interest. Submit Registration
