Elements of SUCCESS Program Application

    Mr.MissMs.Mrs.

    I have read and accept both the LIABILITY WAIVER and the PROGRAM TERMS OF USE YESNO

    I agree that the information presented here is accurate and true to the best of my knowledge, and I agree that my typed name below can be used as a digital representation of my signature to that fact. I understand that this is legally binding and can be used in a court of law.