IPA Kishwaukee Student Leadership Breakfast Registration
It's time to recognize your students who excel as leaders at your school. The Kishwaukee Region of the IPA invites you to participate in our 17th Annual Student Leadership Breakfast. This year we will be having a choice of locations. Hopefully this will make it easier to attend based on location and your school calendar. The first breakfast will be held at 9:00 am, Wednesday, April 12, 2017, at the Radisson Resort and Conference Center in Rockford, Illinois. The second breakfast will be held at 9:00 am on Wednesday, April 26, 2017, at the Crystal Lake Holiday Inn. By holding two events, we are able to meet the needs of our schools and our families. We are shooting for attendance of over 500 people between the two locations.

The Student Leadership Breakfast recognizes tomorrow's leaders today. Each principal is invited to recognize a female and male student from the exiting grade level in his or her building. You decide upon the criteria for selecting each student. Parents of the students are also invited to attend. This successful program has always been well attended and appreciated by parents and students over the past several years.

Each student leader will receive a certificate, a copy of a book on leadership appropriate for each age level, and a picture in honor of his/her recognition. Pictures will be emailed to the email submitted in this registration form.

Additionally, our Region provides several scholarships to high school seniors who attend the breakfast. The recipients of the scholarship will be selected at random. We will be giving out at least four $250 scholarships this year.

The cost is $25 per person. This will cover the expenses for the room, awards, and breakfast. If you register by March 15, the cost will be $20 per person. Principals are responsible for the cost of the students, themselves, and other guests. There will also be a guest speaker. This year, our speaker at the Rockford breakfast will be Joe Burgess, Superintendent of Genoa-Kingston Schools. Mr. Burgess is the recipient of the Kishwaukee West Superintendent of the Year Award. The speaker at the Crystal Lake breakfast will be Dr. Tim Mahaffy, Superintendent of Fox River Grove School District. Dr. Mahaffy is the recipient of the Kishwaukee East Superintendent of the Year Award.

Please complete the Google form and print two copies: one for your records and one to send in with your payment. Please make sure the registration is completed by Friday, March 24 to ensure a table for your school. If you register after March 24, please send me an email to make sure that we are still able to accommodate your party. Please do your best to send the total amount due in a timely manner. It would be best if you could include a print out of your registration with your payment to make sure that it gets credited correctly.

If you have any questions, please call or email Dr. Bridget Belcastro. 815-385-3731 or bbelcastro@johnsburg12.org

Please make checks out to IPA Kishwaukee and mail payment to:
Dr. Bridget Belcastro
c/o Johnsburg Elementary School
2218 W. Church Street
Johnsburg, IL 60051

On behalf of the IPA Kishwaukee Region, I am looking forward to seeing you and your outstanding student leaders this April!

Email address
Which breakfast are you attending?
Name of School
Please use correct spelling, spacing, capitalization, and punctuation. How you type it here is how it will appear in the program and on the student's certificates.
Your answer
Name of Principal
Please use correct spelling, spacing, capitalization, and punctuation. How you type it here is how it will appear in the program.
Your answer
Name of Female Student Leader
Please use correct spelling, spacing, capitalization, and punctuation. How you type it here is how it will appear in the program and on the student's certificates.
Your answer
Grade Level of Female Student Leader
please type the answer numerically with no "th." For example, 8.
Your answer
Phonetic Pronunciation of Female Student Name
For example: Abbeduto- Abb-eh-DOO-doe
Your answer
Name of Male Student Leader
Please use correct spelling, spacing, capitalization, and punctuation. How you type it here is how it will appear in the program and on the student's certificates.
Your answer
Grade Level of Male Student Leader
please type the answer numerically with no "th." For example, 8.
Your answer
Phonetic Pronunciation of Male Student Name
Example: Shumacher- Shoe-mah-ker
Your answer
School Address
Number and street name
Your answer
School City
Please use correct spelling, spacing, capitalization, and punctuation.
Your answer
School Zip Code
Your answer
Principal Email Address
Your answer
School Telephone Number
Your answer
Number of people attending
Please include the total number of people attending including the student leaders. Keep in mind that tables seat 10 people. If you have more than 10 people from your school, you will need to sit at separate tables. It is up to each school to determine if students may invite guests. However, we ask that schools submit one check for the total amount to make bookkeeping easier. All checks must be made out to IPA Kishwaukee.
Your answer
Total Amount Due
Please multiply the number of people attending from your school by $25. Registrations before March 15 are $20 per person. Type the answer below. Do not use $ or decimals.
Your answer
Other important information we should know:
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