"*" indicates required fields Step 1 of 11 9% CompanyThis field is for validation purposes and should be left unchanged.Have you been invited to graduation? Yes No Are you listed on your loved one's visitation list?*YesNoI Don't KnowYou will need to get in contact with your loved one to find out who they have listed as their graduation guests. Who are you coming to see graduate?*Alberto Garcia - 2474957Anthony Brooks - 2344642Antonio Dalco - 2432058Barnabus Cheney - 2576830Bradley Ozee - 2342639Brandom Hill - 2576388Brandon Banda - 2582325Brian Mokua - 2572568Carmenates Suarez - 2583315Colby Moore - 2518692Coma Bradley - 2578206Corrie Devall - 2561090Daniel Nunn - 2591364Darrick Runnells - 2522958David Atherton - 2530729Demontay Campbell - 2539748Dimitri Garcia - 2575290Dominic Barnett - 2585248Dwayne Richardson - 2578258George Carter - 1561528German Gallegos - 2530935Izeal Owens - 2585954Javon Crockett - 2532166Jerald Shipman - 2506843Joel Andrews - 2578279John Baker - 2505946John Lara - 2540328Jonathan Cruz - 2572359Jose Echeverria - 2555162Jose Perez - 2562030Joseph Martire - 1469557Joseph Soria - 2488201Joshua Lujan - 2412973Joshua Palmer - 2349270Justin Smith - 2274223Kaeleb Dejean - 2512736Kenneth Mestas - 2196324Kenny Collins - 2580409Kenute Guy - 2386458Laquinton Fitzgerald - 2517975Lionel Najar - 2544192Louis Bautista - 2586138Manuel Garcia - 2274599Marwan Beauchamp - 2224993Matthew Lee - 2570819Michael Foster - 2581949Michael Hagan - 2579503Michael Martinez - 2473755Michael Taylor - 2439323Michael Woods - 1944222Montreal Baxter - 2331302Nathan Young - 2419216Norman Jones - 2407449Pablo Lopez - 2450065Pablo Moya - 2584820Pompilio Bolanos - 2084727Richard Molina - 2557795Robert Blake - 2561501Robert Soria - 2550906Roberto Aguilarmartinez - 2562336Roberto Marroquin - 2150352Roy Chaney - 2576884Ruben Rodriguez - 2493898Ruben Trevino - 2550652Shawn Kless - 2564493Travis Browning - 1956345Trent Lee - 2072774Trey Bender - 2322882Tyler Lewis - 2558647Tyree Mims - 2579989Xavier Cardoza - 2328816If this participant already has 4 registered guests, you will not be able to submit this form.Each participant may have up to 4 total registered guests. If all spots have already been filled, this form will not allow additional registrations. 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 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-lawFiancĂ©eFriendGirlfriendGodparentGranddaughterGrandparentGrandsonGreat-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?* Email Text Have you ever had a Texas Department of Corrections Number?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* MM slash DD slash YYYY 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* MM slash DD slash YYYY 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* MM slash DD slash YYYY 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?Total Guests in This Submission 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 Monday, May 25th 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! Δ