Intelligence Main Utility You Are Our Future

Youth's Name *

First

Last

Youth's Educational Facility

Guardian's Name *

First

Last

Guardian's Name

First

Last

Guardian's Email *

Guardian's Phone *

Guardian's Email

Guardian's Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Emergency Contact Name *

First

Last

Emergency Contact Number *

Special Instructions

Parental Consent for Child *

Yes, I provide consent.
No, I do not provide consent.

Consent & Recording Release Form (Minor) I agree to allow my child to participate in the usability study conducted and recorded by Intelligence Main Utility LLC (I.M.U). I understand and consent to the use and release of the recording by Intelligence Main Utility LLC. I understand that the information and recording are for research purposes only and that my child’s name and image will not be used for any other purpose. I relinquish any rights to the recording and understand the recording may be copied and used by Intelligence Main Utility LLC without further permission. I understand that participation in this usability study is voluntary and I agree to immediately raise any concerns or areas of discomfort my child or I might have with the study administrator. Please indicate that you have read and you understand the information on this form and that any questions you might have about the session have been answered.

I.M.U Parental Consent

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