2024 California Youth Leadership Summit Panelist Application Form
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
Email *
Street Address *
City *
State *
Zip Code *
Country *
Telephone Number *
Current Employer (if any) *
Are you currently a student? *
Name of school:
Grade/Year
GPA
Have you been a member of an Honors Society? *
Which topics are you interested in? *
Required
How did you hear about us? *
If you are selected, can you submit 2 references from a school teacher or an employer? *
If you are selected, can you commit approximately 10 hours prior to the event for event preparation? *

IF YOU ARE UNDER 18 YEARS OLD:

Sister Cities International Southern California Chapter is asking for your consent to:
● Live stream over the Internet and record your child’s name, image and voice during the California Youth Leadership Summit, and any personally identifiable information shared by your child during the live panel session; and make the recording available on the Internet after the event.

Consent Clause: I hereby consent to the Sister Cities International Southern California Chapter’s live stream and recording of my child's name, image and voice during participation as a panelist in the California Youth Leadership Summit, as well as any personally identifiable information my child may share during the live panel session; and agree to the subsequent release of such recording(s) on the event organizers’ websites and/or social media.

Photo Release: I hereby consent to my child’s photos/images and name to be published on the socalsistercities.org website, social media and in event promotions. I am aware that there are potential dangers associated with the posting of personally identifiable information on the Internet since global access to the Internet does not allow us to control who may access such information.

It is our policy to keep contact information (residential addresses, e-mail addresses and phone numbers) strictly confidential.

I am the parent or legal guardian of the student named below, and hereby fully release and discharge Sister Cities International Southern California Chapter, the event organizers of the California Youth Leadership Summit, and their officers, directors, employees, and agents from any and all debts or liabilities arising out of or in connection with the above-described uses of my child’s name, image or voice, or personally identifiable information shared by my child during the California Youth Leadership Summit.

PARENT: BY TYPING MY NAME BELOW, I AGREE TO THE ABOVE

IF YOU ARE OVER 18 YEARS OLD

Consent Clause: 
I hereby consent to the Sister Cities International Southern California Chapter’s live stream and recording of my name, image and voice during participation as a panelist in the California Youth Leadership Summit, as well as any personally identifiable information I may share during the live panel session; and agree to the subsequent release of such recording(s) on the event organizers’ websites and/or social media.

Photo Release: 
I hereby consent to my photos/images and name to be published on the socalsistercities.org website, social media and in event promotions. I hereby fully release and discharge Sister Cities International Southern California Chapter, the event organizers of the California Youth Leadership Summit, and their officers, directors, employees, and agents from any and all debts or liabilities arising out of or in connection with the above described uses of my name, image or voice, or personally identifiable information I may share during the California Youth Leadership Summit.

BY TYPING MY NAME BELOW, I AGREE TO THE ABOVE
I will record a 1 to 2 minute video introducing myself; explaining why I am interested in being a panelist,  which California Leadership Summit panel topic I am most interested in and why; and my plans/hopes for the future. I will upload the video to this form: https://docs.google.com/forms/d/e/1FAIpQLSc3id5_0Os_cznHoyuAiK3ytqzCG-mSVswVQuGI07DE5EK5pA/viewform?usp=sf_link *
I agree and certify that all information submitted by me on this application is true and complete. I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected or terminated at any time. In consideration of my membership application, I agree to adhere to the policies and regulations of the California Youth Leadership Summit.  I understand that my photograph, likeness or voice may be recorded and published or broadcast.  I also agree to indemnify and hold harmless all organizers of the California Youth Leadership Summit and their partners for all claims arising out of my participation as a panelist. I represent that, to my knowledge, I am in good health and suffer no physical impairment that would or should prevent my participation in panelist activities. *
By typing my name below, I agree to the statement above. *
DATE *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Sister Cities International Southern California chapter. Report Abuse
Google Forms