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Built Different Leadership Collective

Section 1 — Participant Info

Birthday
Month
Day
Year
State

Section 2 — Parent/Guardian Info

Section 3— Participant Questions

5. Are you able to attend all three scheduled sessions.

SECTION 5 — Consent (Parent/Guardian Completes)


PARTICIPATION AGREEMENT, WAIVER & REFUND POLICY

By registering for TheBuilt Different Leadership Collective program (the “Program”), I acknowledge and agree to the following on behalf of myself and/or my minor child:

ASSUMPTION OF RISK I understand that participation in the Program includes group discussion, reflective exercises, and light physical movement activities. While the Program is designed to be safe and developmentally appropriate, participation may involve inherent risks, including minor physical injury or emotional discomfort arising from discussion and self-reflection. I voluntarily assume all risks associated with participation.

RELEASE OF LIABILITY I release and hold harmless The Leadership Collective, Kevin Primerano and Optima Mindset Coaching, Aaron Goldman and PLAYfree Sports, and their respective owners, employees, contractors, and agents from any and all claims, liabilities, damages, or causes of action arising out of or related to participation in the Program, except in cases of gross negligence or willful misconduct.

MEDICAL AUTHORIZATIONIn the event of a medical emergency, I authorize Program leaders to seek appropriate medical care for my child. I understand that I am responsible for any medical expenses incurred.

HEALTH & PARTICIPATION REPRESENTATION I affirm that the participant is physically and emotionally able to participate in the Program and that any relevant medical, behavioral, or psychological conditions have been disclosed during registration.

EDUCATIONAL NATURE OF PROGRAM I understand that the Program provides leadership and mindset education. It is not medical care, mental health treatment, counseling, or therapy, and does not replace professional services.

REFUND POLICY Full refunds are available up to seven (7) days prior to the Program start date. Cancellations made fewer than seven (7) days before the Program begins are non-refundable, regardless of reason. No refunds or prorated credits will be issued for missed sessions. If the Program is cancelled by The Built Different Leadership Collective, a full refund will be provided.

By signing my name below, I certify that I am the parent or legal guardian of the participant (if under 18), that I have read and understand the Participation Agreement, Waiver & Refund Policy above, and that I agree to its terms. I understand that typing my name constitutes my electronic signature and is legally binding.

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Fee
$175
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