Hope4Life Membership Form
TO THE PARENTS
Our mission is to equip your child/children with the tools that will enable them to avoid negative influences and instead, allow them
to focus on their strengths and potential to achieve their goals.
HOPE 4 LIFE will give young people the skills needed to recognize
TO THE CHILDREN
HOPE 4 LIFE
in gangs and violent activities, recognize and focus on your individual strengths, develop good decision-making skills, provide you
with the skills needed to recognize and resist the peer pressure to experiment with drugs and alcohol. You are responsible for yourself
and we will assist you in being all you can be.
will provide you with the key elements for success: Live a drugs, alcohol and tobacco free life, avoid being involved
FREE MEMBERSHIP CARDS
The ISL (Island Soccer League), CellularOne, Fairmont Bermuda Properties, and the Ministry of Labour Home Affairs and Housing
encourage all students and parents to register for the
will be a $2.00 charge for a replacement. Your membership card will entitle you to:
HOPE 4 LIFE membership card. Should you lose your membership card there
Contact information for other community programs (Family Centre etc.)
Discounts for ISL games, merchandise and special events
Discounts at participating retail stores and restaurants in Bermuda
Automatic registration for various giveaways throughout the year
Complete the form below and return to any CellularOne store. Once your membership card has been produced you can pick it up at
Burnaby Street or Reid Street CellularOne stores (please indicate below).
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TO REGISTER, COMPLETE FORM AND RETURN TO CELLULARONE
PARENTS NAME:_______________________________________________________________DOB:___________________________________
OCCUPATION:_________________________________________________________________________________________________________
CONTACT NUMBER:__________________________________EMAIL:__________________________________________________________
STUDENT NAME:_____________________________________________________________DOB:_____________AGE:____GRADE:_______
SCHOOL NAME:______________________________________________EMAIL:__________________________________________________
MAILING ADDRESS:____________________________________________________________________________________________________
TO RECEIVE EMAIL UPDATES: YES____NO____
PICK UP MEMBERSHIP CARD: BURNABY STREET___REID STREET___
I, the student and parent(s) have read and fully understand the information provided above. We pledge to do our best to live up to the key
elements provided by HOPE 4 LIFE.
Date:_________________________
Parent’s signature:_______________________________________________
Students signature:_______________________________________
Sponsored in part by the Ministry of Labour Home Affairs and Housing
and resist the subtle and overt pressures that cause them to experiment with drugs or become involved in gangs or violent activities.
With your support, we can spread the message of resisting peer pressure and reveal positive alternatives to drug and alcohol use.
