Youth Leadership Program Application
First Name *
Last Name *
School *
Grade *
Email *
Home Address *
City *
Zip *
Home Phone *
Cell Phone *
Community Activities *
In what school or community activities are you involved, and which one gives you the most satisfaction and why?
Previous Applicant *
Have you previously applied to the Youth Leadership Program sponsored by the Future Foundation?
Conflicts *
Do you have any conflicts that will prevent you from participating in all of the sessions which will take place on Wednesday afternoons from 4:00-5:30? (See information sheet for specific dates.) If so, please explain.
Program Interest
The 8 week curriculum will include sessions on Leadership, Local Government, Law Enforcement, Health Programs, Recreation, Education, Community Services, and Business. Write a short paragraph, (200 words maximum per question), in answer to the following four questions.
What do you hope to get out of the program? *
How do you personally define leadership, or what characteristics or qualities do you believe positive leaders need to possess? Additionally, what leadership traits do you need to develop and why? *
What does being a role model mean to you? Describe how you have been a role model to other students. *
What obstacle have you had to overcome? *
If accepted into the program, what roles are you likely to take on? *
Required
Agreement *
My child has my permission to attend the Youth Leadership Program. I understand that transportation is not provided and that community service credit is based on attendance. Conejo/Las Virgenes Future Foundation reserves the right to use photos/video taken during activities/programs for publicity purposes. Supervision is only provided during meeting times, from 4:00 p.m.- 5:30 p.m. The undersigned hereby agrees to defend, indemnify and hold harmless the Conejo/Las Virgenes Future Foundation, and its officers, employees and agents from and against any and all loss, liability charges and expenses, (including attorney's fees) and cost which may arise by reason of participation in this program. The Foundation does not provide accident, medical, liability, workers compensation insurance or any other insurance for program participants. As parent/guardian, I hereby consent to emergency treatment of my minor child as a result of accident or injury. I further agree to pay any and all costs incurred as a result of said treatment.
Required
Parent Name *
First & Last Name
Parent Email *
Parent Phone Number *
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