IMAGES Application

IMAGES

Student Application
Student Information

Please complete all fields below. A valid email is required
Student Full Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Email
example@example.com
Parent/Guardian Information

Please complete all fields below
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Phone Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Student Profile
What are you looking to get out of our program? Select one
Current School
Current Grade
Cumulative GPA
Career Interest
Please list what your future career goal
What are looking to get out of the program?
Are you able to commit to the monthly meetings?
Do you have reliable transportation?
This program brings young ladies together in a group setting. What made you interested in joining and what are you hoping this group will be like for you.
Please sign and date form

Emergency Contact

Please list up to three emergency contacts
  Emergency Contact 1
First Name*   First Name*   Last Name*     Area Code*   Phone Number*
Emergency Contact 2

First Name* Last Name* Area Code* Phone Number*
  Emergency Contact 3


First Name*   Last Name*      Area Code*   Phone Number*

Parent/Guardian Consent

If my daughter is selected to participate in the 2026 1926 Foundation IMAGES Program, I give my permission for her to participate and commitment to monthly meetings: (please initial each)
Please initial here to ensure full participation in the IMAGES program
Parent/Guardian Full name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Signature
I acknowledge that meeting these financial obligations and deadlines is essential for my daughter's complete participation in all cotillion activities.
Student Full Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

1926 Foundation Incorporated Image Release

I grant the 1926 Foundation Incorporated their representatives and members (hereinafter “Committee”) the right to take photographs, videos, or other visual media of me and my property in connection with the IMAGES program: I authorize the Committee, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that the Committee may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Website content. I have read and understand the above.
Parent/Guardian Full Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

IMAGES