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JTY Leadership Program
JT–LVL 2 Program: Creative Business & Social Media Foundations
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Booking Request Form

Jestin Time Youth Leadership & Community Program Form

By completing this form you are applying for your child to participate in The Jestin Time Leadership & Community Youth Program that is a hands-on creative experience involving balloons and water-based face paint. Participation is voluntary and supervised.

Parent/Guardian First Name *

Parent/Guardian Last Name *

Phone Number *

Email Address *

Student Name *

Student Age *

Session Choice *

June 3 - 7, 2026
June 17 - 21, 2026
July 1 - 5, 2026
July 15 - 19, 2026
July 29 - August 2, 2026
August 12 - 16, 2026

Does your child have any allergies (latex, face paint, etc.)? *

No
Yes (please explain):

Allergy Explanation (Put N/A if Non-Applicable) *

Any medical conditions or concerns we should be aware of? *

Is your child comfortable participating in group activities? *

Yes
Somewhat
No

My child has permission to: (Select all that apply) *

Participate in balloon artistry activities
Participate in beginner face painting activities
Use provided materials (balloons, paint, tools)

Photo / Media Release *

I give permission for my child to be included in photos/videos for promotional use
I do NOT give permission

Emergency Contact Name *

Emergency Contact Phone *

I understand this is a hands-on creative program and agree that my child will participate respectfully and follow instructor guidance. *

I agree

By submitting this form I agree to the Terms of Service for the "Jestin Time Youth Leadership & Community Program" *

Yes

Leave this field empty

**Terms of Service for the "Jestin Time Youth Leadership & Community Program"**

🎪 Thank you for helping build the laughter!

~ Jestin Time, The Laugh Architect ~