Youth Leadership Conference - Registration
Event Dates: July 12-16, 2021
Event Address: TBA, Elizabeth City, NC
Cost: Free for all youth
Contact us at (252) 562-4337 or iEmpowerNC@gmail.com
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Youth Name (rising 5th-9th graders) *
School *
Grade Level (2021-2022 school year) *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Parent Email *
Emergency Contact Name & Relationship *
Emergency Contact Phone Number *
Food Allergies (if yes, please list them) *
Youth's T-Shirt Size *
How did you hear about the event?
Daily Transportation: I will provide transportation to drop him/her off (8:15-8:45am) and pick him/her up (3:30-4:00pm) on Monday-Friday during the week of the conference. *
Transportation Consent: My child has my permission to ride to and from the community service activities on Friday, July 16th with iEmpower, Inc. staff and/or volunteers. *
Optional Photo Permission *
Required
I acknowledge that additional consents/paperwork may be required before my child can participate in this event. (Additional information will be provided closer to the dates of the event.) *
Required
I acknowledge that I must have my child COVID tested, yielding negative results prior to my child attending the conference. (Additional information will be provided closer to the dates of the event.) *
Required
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