Enrollment Form

On-line Enrollment

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Gender *
Annual Household Income *
Do you have standing appointments that will keep you from attending class? *
Will transportation be an issue for you, given the location of the class and the meeting day(s)/time(s)? *
Will childcare be an issue for your during the scheduled class times? (Children are not permitted in the classroom) *
*For locations providing child guided activities, please provide the name, age and gender for each child attending.
 NameAgeGender
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Authorization to Use Photographs, Images, etc:  I do hereby give permission to Omaha Bridges Out of Poverty, Inc., its employees, and representatives, to take photographs and/or other images of me or my property, for the sole use of promoting, advertising and marketing Omaha Bridges Out of Poverty, Inc. Any other use of such photographs or other material is not authorized. This authorization applies to use on the Omaha Bridges Out of Poverty website, brochures or other materials created and designed for the business use of Omaha Bridges Out of Poverty, and its social media sites, including but not limited to Facebook, Instagram, Twitter and SnapChat. By selecting "Yes," I am affirming that I have read, understand and grant authorization. *
General Content - Release of Information:  I agree that Omaha Bridges Out of Poverty, Inc. (OBOP) may release my Getting Ahead and Getting Going information to any of its “Partner Agencies” with which it has a signed confidentiality agreement for the purpose of helping me to achieve the goals I developed in Getting Ahead in a Just Gettin By World and after graduation from Getting Ahead in a Just Gettin By World, and OBOP may obtain confidential information from said Partner Agencies. This Release of Information continues in effect until I revoke this consent in writing. *
Release of Liability Waiver:  I am voluntarily participating in the Getting Ahead in a Just-Gettin’-By-World class offered by Omaha Bridges Out of Poverty, Inc. I understand that participation in the afore-mentioned class may involve risks that include, but are not limited to, natural disasters; political, legal, social, and economic conditions; disease; injury; crime; and different standards of design, safety, maintenance and accessibility of buildings and other public places. I agree, on behalf of myself and my legal representatives, heirs, successors and assigns, to assume all risks and responsibilities surrounding my participation in the Getting Ahead class. In consideration for the opportunity to participate in the Getting Ahead class offered by Omaha Bridges Out of Poverty, which includes a financial stipend at its conclusion, I hereby release Omaha Bridges and its directors, officers, employees, agents, successors and assigns from any and all claims, causes of action, liabilities and costs which I may have that arise out of my participation in the Getting Ahead class. I understand that this Release of Liability, as described in the above paragraph, is intended to be as broad and inclusive as permitted by the laws of the State of Nebraska. I agree that if any portion of the above paragraph is deemed invalid, the remainder will continue to be in full force and effect. This Release of Liability Waiver is to be interpreted and enforced under Nebraska law. *
Please provide your electronic signature *
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