U THE TEEN LEADER ENROLLMENT FORM Confirm Class Dates:*Teen Leader: August 4-6, 2023Prefix*Ms.Mr.Student Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Student Email* Student Phone*Student Age*Student Grade* Parent/Guardian Name* First Last Parent/Guardian Email* Parent/Guardian Phone*Second Parent/Guardian/Family Member Name* First Last Second Parent/Guardian/Family Member Email Second Parent/Guardian/Family Member Phone*Please note that parents/guardians/family members noted above will be considered emergency contacts. If neither of these people will be available during the training weekend, please reply to the enrollment confirmation with a backup contact name and phone number.Who referred you to U & Improved?* Refunds & Rescheduling Policy* I have read and agree to the terms of the Refunds & Rescheduling Policy. Refunds: We do not issue refunds. Please notify us within 14 business days if you need to reschedule your class date to avoid a rescheduling fee. Rescheduling: All classes are subject to a rescheduling fee of up to $350. To avoid the fee, please notify us within 14 business days of the class start date that you need to reschedule.