Step 1 of 11 9% Thank you for signing up as one of four graduation guests per participant!Who Are You Coming to See Graduate?* Graduate's First Name Graduate's Last Name (The name of the man in PEP) Your FULL Name EXACTLY as it appears on your drivers license or passportIf you go by Tom but your Drivers License says Thomas, please enter "Thomas."Name* First Last Please provide your address as it appears on your drivers license or passportAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you listed on your loved one's visitation list?*YesNoI Don't Know Finish this sentence: I am his...*AuntBrotherBrother-in-lawChild's motherCommon-law wifeCousinDaughterDaughter-in-lawDistant RelativeEx-father-in-lawEx-girlfriendEx-mother-in-lawEx-wifeFatherFather-in-lawFiancéeFriendGirlfriendGodparentGranddaughterGrandparentGrandsonGreat-grandparentHalf brotherHalf sisterMotherMother-in-lawNephewNieceSisterSister-in-lawSonSon-in-lawStep-brotherStep-daughterStep-fatherStep-motherStep-sisterStep-sonUncleWife Please list the best ways to contact you in case we have any follow-up questionsEmail*If you don’t have an email address, please enter FAMILY@PEP.ORG Enter Email Confirm Email Phone*Do you prefer email or text notifications with important updates?*EmailText Were you ever a TDCJ offender?If you do not know what this question means, choose No.No, I am not a former TDCJ offenderYes, I am a former TDCJ offender. I am STILL on parole or probation.Yes, I am a former TDCJ offender. I am NOT currently on parole or probation.You need to bring a letter from PO giving permission to attend graduation* I understand. Minors need to be on the guest listAre you bringing a minor/child who is on the guest list?*NoYesHow many minors/children will attend with you?*123Minor 1 - Name* First Last Minor 1 - Birthdate* You are REQUIRED to provide a full birthdate for any minors.Minor 1 - What is the relationship to the graduate listed above?*Son? Daughter? Nephew? Cousin?Minor 2 - Name* First Last Minor 2 - Birthdate* You are REQUIRED to provide a full birthdate for any minors.Minor 2 - What is the relationship to the graduate listed above?*Son? Daughter? Nephew? Cousin?Minor 3 - Name* First Last Minor 3 - Birthdate* You are REQUIRED to provide a full birthdate for any minors.Minor 3 - What is the relationship to the graduate listed above?*Son? Daughter? Nephew? Cousin? Will you need to bring any medicine/medical devices into the Unit with you to graduation?YesNoEX: insulin, inhaler, oxygen tank, wheelchair, etc.Please provide a detailed description, including any drug prescription name(s)* What is your biggest hope when he is released? What is your biggest fear when he is released? What will your role be as he transitions back into society to help him stay free? Required Waiver of Liability, Media Release, Attendance Requirements AgreementIN CONSIDERATION for being permitted to participate in activities of the Prison Entrepreneurship Program ("the Program"), THE UNDERSIGNED, for himself/herself, his/her personal representatives, heirs and next of kin: 1. Agrees that he/she appreciates the risk of injury during his/her participation in the Program and further agrees that he/she assumes full responsibility for his/her own safety and for determining that no dangerous conditions exist that could affect his/her own safety at any of the sites; 2. Agrees that his/her participation in the Program acknowledges that he/she finds the sites as being reasonably safe for the purpose of his/her use, and further agrees that if, at any time he/she feels anything to be unsafe, he/she will immediately withdraw from the dangerous area; 3. Acknowledges that in the course of his/her participation during in-prison events or other PEP sponsored activities, video or photographs may be taken or illustrations may be made of him/her and further agrees to allow, without compensation, his/her likeness to appear in material, regardless of media form, promoting the Program, its events and activities, including those of its representatives and licensees; 4. Releases, waives, discharges and covenants not to sue Prison Entrepreneurship Program or any subdivision thereof, and each of them, their officers and employees, (hereinafter as "Releasees") from all liability to the undersigned, his/her personal representatives, assigns, heirs and next of kin for any and all loss or damage and any claim or demands therefrom on account of injury to the person or property or resulting in death of the undersigned en route to/from the site, in or upon the site or while observing, working for or participating in the Program; 5. Agrees to hold harmless and to indemnify the Releasees from and against all claims, actions, damages and expenses, including but not limited to reasonable attorney's fees for any alleged injury and/or death to any person or damage to any property arising or alleged to have arisen out of any negligent, reckless or intentional act of the undersigned or failure to act on the part of the undersigned, his/her heirs, successors or assigns; and 6. Agrees that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by laws of the State of Texas and that if any portion thereof is held invalid, the balance shall continue in full legal force and effect. I understand that: - A maximum of four family/friends will be allowed to attend - No substitution of the guests will be accepted - All guests must be registered by December 31st, 2024 I have read and voluntarily signed this Waiver of Liability and Media Release Agreement and further guarantee that no additional oral representations, statements or inducements have been made.Please Verify your Agreement* I Agree to the above Waiver of Liability and Media Release Agreement If you do not check this box, your registration is incomplete and you will not be allowed to attend graduation.FILL OUT THE FORM COMPLETELY! If this form is not filled out completely then this application for attending graduation could be denied. You must hit SUBMIT below for this form to be sent!CommentsThis field is for validation purposes and should be left unchanged.
