MY Leaders Summer Program 2025 Registration Form
MY Leaders Summer Program Registration 2025
Our Youth Leadership Program is a transformative experience for young people aged 14 - 24 years old focusing on personal growth, community building, and advocacy for underserved communities and the minority population. Participants will engage in hands-on activities, workshops, and projects that empower them to become leaders who make a positive impact in their communities. The MYL Youth Leadership program provides a comprehensive leadership development experience that introduces students to the importance of leadership in their own lives, how to embrace their unique strengths and personality, and how to find who they are and wish to become.
Benefits:
- Develop leadership skills and confidence
- Build strong relationships with peers and mentors
- Advocate for social justice and equity in underserved communities
- Gain valuable experience for future academic and career opportunities
- Master interpersonal skills and public speaking
- Learn about different cultures and perspectives
Features:
- Leadership Curriculum
- Community Service involvement
- Advocacy Seminar planning and presentations
- Mentorship Opportunities
- Personal Growth Activities
- Networking opportunities
- 16 class sessions + scheduled additional events or field trips over the summer
- Meet community leaders
- Community Impact Tracking
Days & Times:
Mondays and Wednesdays 12-3pm
Saturdays: 10am-2pm
Other dates and times for special events will be shared at the Orientation Sessions. Please plan to attend one of the following:
Session 1: June 28th orientation at 11:30pm
Session 2: June 30th at 12:30pm
Dates:
June 30 - Aug 30th

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Email *
MY Leaders
First and Last Name  *
Date of Birth  *
Age  *
Phone Number  *
Address *
Name of School *
Grade for the 2025-2026 school year *
MY Project USA will provide transportation from these four locations:
Wedgewood Village Apartments
Southpark Apartments
Westhaven Apartments
Havenwood Apartments

Will you require transportation from any of these locations? *
Meals will be provided during a lunch break in the session. Please list any allergies or any special accommodations needed. 
Parent's Information:
To be completed by parent/guardian for youth under the age of 18
Parent/Guardian's First & Last Name *
Phone Number  *
Email  *
Emergency Contact (Other than parent/guardian) *
Emergency Contact Phone Number  *
Relationship to Youth *
Permissions, Consent, & Waivers:
To be completed by parent/guardian for youth under the age of 18 years of age
Parent/Guardian Consent/Permission to participate in programs:

As the parent/guardian of the participant, I grant permission for my child to participate in the MY Leaders Summer Program. I understand the nature of the program and the activities involved and agree to hold harmless the program organizers, mentors, and associated staff for any accidents, injuries, or damages that may occur during the program. 

Parent/Guardian: Please Sign First & Last Name Below 
 *
Media Release:

I grant permission to the MY Leaders Program and its representatives to use photographs, videos, and other media captured during the program for promotional and educational purposes. This includes, but is not limited to, the program website, social media platforms, printed materials, and media releases to local newspapers or news outlets.

I understand that my participation is voluntary, and I will not receive any compensation or financial remuneration for the use of such media.

Parent/Guardian: Please Sign First & Last Name Below 
 *
Transportation Waiver:

Assumption of Risks: I understand that transportation involves inherent risks, including but not limited to accidents, injury, or property damage. I acknowledge that MY Project USA, its staff, and volunteers will take reasonable measures to ensure safety, but they cannot guarantee absolute safety during transportation.

Consent for Transportation: I grant permission for my child to participate in transportation organized by MY Project USA for the MY Leaders program. This transportation may include, but is not limited to, travel by private vehicles, buses, vans, or other means of transportation deemed appropriate by the organizers.

Release and Indemnification: I release MY Project USA, its directors, officers, employees, and volunteers from any and all liability, claims, demands, actions, or causes of action arising out of or related to transportation provided by MY Project USA for the MY Leaders program. I agree to indemnify and hold harmless MY Project USA and its representatives from any liability incurred as a result of my child's participation in transportation activities.

Medical Authorization: In the event of an emergency, I authorize MY Project USA and its representatives to seek medical treatment, including but not limited to emergency medical care or hospitalization, for my child if necessary. I understand that every effort will be made to contact me or the emergency contact provided before medical treatment is administered.

Responsibility of Parents/Guardians: I acknowledge that it is my responsibility to ensure that my child is present at the designated pick-up point at the agreed-upon time for transportation. I will notify [Your Organization's Name] in advance if my child will not be utilizing the provided transportation for any activity.

Seat Belt Usage: I understand that my child is required to wear a seat belt at all times when transportation is provided by MY Project USA. I will ensure that my child understands the importance of wearing a seatbelt and will encourage their compliance with this safety measure.

Updated Contact Information: I will promptly notify MY Project USA of any changes to my contact information, including phone numbers, email addresses, and emergency contact details.

I have read and understood this Transportation Waiver and agree to its terms and conditions. I acknowledge that by signing below, I voluntarily waive certain legal rights and agree to release MY Project USA from any liability associated with transportation provided for the MY Leaders program.  

Parent/Guardian: Please Sign First & Last Name Below 
 *
A copy of your responses will be emailed to the address you provided.
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