2. Register for the 2023 Teen Broadcasting Club

   Program begins Monday, May 22nd

   • Mass Media Mondays - 5-6pm
   • Filming Footage Fridays - 5-6pm
   • Show-Stopping Saturdays - 2:30-4:30pm
6. TELL US ABOUT YOURSELF:
8. Name: (First and Last)*
10. Date of Birth:*
12. Email Address:*
14. Phone Number:*
16. How did you hear about the program? (school, organization, etc.)*
20. What are you interested in?
22. What Parts of Broadcasting Interest You?*

    Check all that apply

    1. Filmmaking
    2. Video Editing
    3. Acting
    4. Writing
    5. Interviewing
    6. Podcasting
    7. Other
24. Other:
26. Applicant Signature: *
28. Date:*
32. PARENT CONSENT
34. Medical Emergencies Involving Minors:
36. In the event that a parent or legal guardian cannot be reached in a medical emergency, the DeSoto Public Library is authorized to arrange for emergency medical treatment, the cost of which will be the sole responsibility of the parent or legal guardian.
38. In case of emergency, please provide 3 contacts (provide first and last name, relationship, and phone number):*
40. Does your child have any medical conditions in which you would like to inform us (for example, asthma, allergies, diabetes, etc.?) If so, explain:*
42. Parent/Legal Guardian Permission:*

    1. Yes I give my permission for my child to be a teen volunteer at the DeSoto Public Library
    2. No I do not give my permission for my child to be a teen volunteer at the DeSoto Public Library
44. I authorize the DeSoto Public Library to arrange emergency medical treatment, in case of an emergency. I understand that my son/daughter will not receive monetary compensation or be insured by the Library.
    Please provide your name and date below.
46. Parent/Legal Guardian Signature:*
48. Date:*
52. For additional information contact Ms. Marq Runnels at 972.230.9663.
54. 
    
56. 
    
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field