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Taste of Independence Program Registration

Tues. August 6, 2024



Is (are) the youth you are registering between the ages of 14 and 18? If no, please contact us at (716) 338-0170

I give permission for the people listed on this registration to have their picture or video taken a the Chautauqua Children's Safety Education Village and to have these photos or videos as a part of a press release, on our website, in any media including Facebook, Instagram and other social media sites, on television, in videos created to display our classes for advertising purposes. I confirm that I am the legal parent or guardian of the child on this application form.