Deanwood Registration Form Name* First Last Address* Street Address City State / Territory ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Enter Email Confirm Email Date of Birth*Please only register if you are at least 13 1/2 years of age AND not yet had your 24th birthday. We cannot accept registrations outside this age range! MM slash DD slash YYYY Parent/Guardian EmailRequired for registrants under the age of 18. Optional for adults. Enter Email Confirm Email Parent/Guardian Name First Last Gender*Gender does not influence eligibility. We collect demographic information for the sole purpose of reporting (grants, yearly reports to Congress, etc.). If the participant is uncomfortable reporting this information, they may choose "Identify as other/Prefer not to report." Female Male Gender Variant/Non-Conforming Other/Prefer not to report Race/Ethnicity*Race and/or ethnicity in no way influence eligibility. We collect demographic information for the sole purpose of reporting (grants, yearly reports to Congress, etc.). If the participant is uncomfortable reporting this information, they may choose "Unknown/Prefer not to report."Select OneUnknown/Prefer not to reportAmerican Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderHispanic or Latino or Spanish Origin of any raceWhiteTwo or more racesCurrent School Advisor's Name*You must choose an Advisor who will serve as your mentor for The Congressional Award. This can be anyone BESIDES your parents, relatives, or peers. First Last Advisor's Address* Street Address City State / Territory ZIP / Postal Code Advisor's Email* Enter Email Confirm Email Advisor's PhoneHow did you hear about The Congressional Award?*-Select-Congressional Award Participant / AlumniCongressional Award WebsiteCongressional OfficeFamily / FriendI Don't Quit Tour (IDQ - Mateo Magdaleno)Internet / Search EngineSchoolSocial MediaWord of MouthYouth / Service OrganizationOtherWaiver and Agreement* I agree to the following Congressional Award ("Program") rules and requirements:• I will select the activities I will perform in order to earn a certificate or medal. • I will not attempt to perform any activity until I have made certain that I can perform it safely. • No one is authorized by the Program to: (i) advise as to the safety of any activity or as to whether I am prepared to perform it safely, or (ii) supervise or exercise any control or authority over me or any other participant. • I hereby release and hold harmless each of the individuals and legal entities involved in the Program from any and all liability of any kind for any injury I might suffer while performing any activity in connection with the Program. • Information about me and my participation in the Program may be publicized by the Program. • This agreement shall remain in effect as long as I am participating in the Program.Participant Signature*Parent/Guardian Signature(Required for participants not considered adults under state law, generally those under 18 years old). I am a parent or legal guardian of The Congressional Award participant listed above. We have read the foregoing Waiver and Agreement and agree on behalf of ourselves and the participant to the terms thereof. We will assure ourselves that the participant is aware of the risk involved in each activity and we take full responsibility in lieu of the Program for each activity.