PAS Richmond – Student Registration Form

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2022 Richmond Prejudice Awareness Summit Student Information & Permission Form

Please type out full name of school
email address of school contact / educator that asked you to submit this form
(Note that VCIC will do our best to meet all requests.)
  • I give permission for my child to participate in the 2022 Prejudice Awareness Summit (PAS) conducted by the Virginia Center for Inclusive Communities on October 21 at VCU’s Harris Hall. I understand that PAS is a human relations program that deals with mature subject matters possibly including stereotypes, prejudice, communication, racism, sexism, religious bias, etc.
  • I understand that although the program sponsor has taken precautions to provide proper organization, supervision, instruction, and equipment for each activity, it is impossible for the sponsor to guarantee absolute safety. I also understand that each participant shares the responsibility for safety during all activities and I assume that responsibility for my child. I waive any claim that may arise against the Board of Directors of the sponsor, and/or its employees, agents, volunteers, or lessors including those claims which may arise from the negligence of the sponsor, their Board of Directors; and/or its employees, agents, lessors or volunteers.
  • I understand that student participants are asked to complete a written evaluation that assesses their views on human relations issues and the PAS program. I give permission for my child to complete such forms.
  • I give permission for my child to be photographed or videoed by sponsors and/or others approved by sponsors at the Prejudice Awareness Summit.
Sign on the line with mouse cursor or with your finger on a touchscreen.
Signature is required.

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