STRONG FUTURE REGISTRATION FORM

Batteries Included Teen Council is an out of school time program that provides teens with a variety of activities which focuses on leadership, education, workforce development, college preparation, civic engagement and healthy living. The Batteries Included program is year-round providing organized special events, retreats, college tours, all FREE of charge. Each Batteries Included Teen Council is assigned an adult advisor who is present at all teen council meetings and special activi- ties. The adult advisors are in place to provide guidance and advice to council members. Check with your teen’s Batteries Included site for meeting dates and times. For more information call (702) 229-4075 or visit www.lasvegasnevada.gov/batteriesincluded

BATTERIES INCLUDED TEEN COUNCIL REGISTRATION FORM We are always looking for new members to join Teen Council.

Name:______Date of Birth:______

Address:______Zip Code:______

Home Phone Number:______Cell Phone:______

Grade Level______E-mail:______

Graduation Date:______School Attending:______

For ourselves and/or on behalf of our child named below, our heirs, executors and administrators, we hereby expressly and forever waive and release the city of , and all their respective officers, employees, agents or representatives from any and all personal injuries or damages sustained, incurred, arising from, or connected with the program or activity described herein, including classes, tournaments and/or special events, and all activities related to, or in connection with, said activity of our child.

Parent/Guardian Name:______

Parent/Guardian Signature:______Date:______

Phone Number:______Cell Phone:______

E-mail:______

TTY# Participant Signature:______Date:______

Indicate the Council you would like to attend. You will be contacted on the meeting dates and times.______7-1-1 STRONG FUTURE

TEEN COUNCIL LOCATIONS CONTACT

Bonanza High School Teen Council 6665 Del Rey Ave. (702) 799-4000 Canyon Springs High School Teen Council 350 E. Alexander Road (702) 334-3425 Cheyenne High School 3200 W. Alexander Road (702) 799-4830 Cimarron Memorial High School Teen Council Buffalo Drive & Tenaya Way (702) 578-2739 Cimarron Rose Community Center Durango Drive & Ann Road (702) 229-1607 Doolittle Community Center Teen Council J Street & Lake Mead Boulevard (702) 229-6374 East Las Vegas Community Center Teen Council N. Eastern & Stewart avenues (702) 229-6242 Legacy High School Teen Council W. Deer Springs Way & 215 Beltway North (702) 799-1777 Las Vegas Academy High School Teen Council 315 S. 7th St. (702) 799-7800 Mirabelli Community Center Teen Council Jones Boulevard & U.S. 95 (702) 229-6359 Peterson Academic Center 10250 W. Centennial Pkwy. (702) 799-6610 Teen Council 1900 E. Searles Ave. (702) 229-2330 Stupak Community Center Teen Council Boston Avenue & Las Vegas Boulevard (702) 229-2488 Valley High School Teen Council 2839 Burnham Ave. (702) 799-5450 Veterans Memorial Leisure Center 101 Pavilion Center Drive (702) 229-1100 West Preparatory High School Teen Council 2050 Sapphire Stone Ave. (702) 372-9887 Western High School Teen Council 4601 W. Bonanza Road (702) 229-2330

YD-0043-08-17 MD