Legacy Leaders Lounge Intake Registration Application

Powered by Life’s A Brie’s Financial Solutions

Parent/Guardian Information

Parent/Guardian Full Name *

Relationship to Child *

Phone Number *

Email Address *

Home Address *

City *

State *

Postal Code *

Best Way to Contact You *

Phone Call

Text Message

Email

Child/Student Information

Child’s Full Name *

Child’s Date of Birth *

Child’s Age *

Grade Level *

School Name *

Financial Literacy Education

Does your child’s school currently offer financial literacy education/classes? *

Medical Information & Allergies

Does your child have any allergies, medical conditions, dietary restrictions, or accommodations we should be aware of? *

If yes, please explain in detail

Emergency Allergy Instructions (if applicable)

Does your child carry an EpiPen, inhaler, or medication?

If yes, please explain

Program Selection

Please select the program you are registering for *

Tiny Hands: Big Plans Introductory financial literacy program for younger children.

Relationship to Child

Legacy Leaders Lab: Interactive financial learning with real-world money activities and leadership development.

Young Adult Foundations: Teen/young adult readiness program focused on financial independence and responsibility.

Not Sure Yet — I Need Help Choosing

Financial Literacy Goals

Emergency Contact Information

Emergency Contact Full Name *

ReIationship to Child *

Emergency Phone Number *

Alternative Phone Number *

Parent/Guardian Consent

PERMISSION *

I give permission for my child to participate in Legacy Leaders Lounge programs through Life’s A Brie’s Financial Solutions. I understand these programs are educational and designed to teach age-appropriate financial literacy and life skills.

ACKNOWLEDGE *

I acknowledge that it is my responsibility to inform staff of any changes regarding allergies, medical concerns, emergency contacts, or accommodations.

Parent/Guardian Signature *

Clear

Date *

Photo & Media Release

Do you give permission for your child to appear in photos/videos for educational or promotional purposes? *

Additional Notes or Concerns

Stay Connected

Would you like to receive updates about future workshops, programs, and events from Legacy Leaders Lounge? *

© 2026 - All rights reserved - Legacy Leaders Lounge