Participant Name:_____

Phone Number: ___

Participant Email: _____

Participant Signature: ___

Parent/Guardian Acknowledgment

I have reviewed the Kentucky State University SOAR Program Student Code of Conduct with my student. I understand the expectations and consequences outlined in this agreement and support my student's participation in the program.

Parent/Guardian Name: ___

Relationship to Student: _____

Parent/Guardian Phone Number: ___

Parent/Guardian Email: ___

Parent/Guardian Signature: ___