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This form services as a release of liability, The Arkansas Martin Luther King, Jr. Commission and its sponsor shall not assume responsibility for individuals, students, participants, persons involved in this program at the stated location, traveling to or from, internal and external structural transportation, in case of injury suffered during, before or after program. Damaged, lost or stolen property shall be the responsibility of the owner thereof. All emergency contacts will be kept and managed by the representing business and/or organization.

Please select the program name you would like to participate in. 
We will contact you be phone or email to coordinate with you.

Signature of Parent/Guardian/Chaperon required if participant/volunteer is under the age of eighteen (18). In addition registrants are automatically signed up as prospective members of the Dream Keepers Program (Ages 17 and under) or the L.E.A.D. Program (Ages 18 and older).

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501 Woodlane Drive, Suite 122 South | Little Rock, AR 72201 | (501) 683-1300  

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