Triangle South Workforce Development Board’s2013 Youth Rally

REGISTRATION FORM

REALITY TV vs. the real world

Name: ______Adult Chaperone _____ Youth ______

Mailing Address: ______

City: ______State: ______Zip: ______

Phone: ______Email: ______

Gender: Female ______Male ______Age ______

Local Area or County: ______

Your career choice:______

Registration Fee: FREE!!!

Do you require a special need or accommodation? ______If yes, please explain ______

______

Do you have any special dietary needs? ______(i.e. vegetarian, gluten free etc…) If yes, please indicate your preference on food. ______

2013 Youth Rally Waiver and Release

I am the parent/legal guardian of the aforementioned 2013Triangle South Workforce Development Board’s Youth Rally participant. I agree to waive and release any and all claims arising from or in any way connected with the Rally and any accident or injury, which may occur. This release waives any claims against the group and respective agents. The undersigned parent/legal guardian agrees that, if any claim is pursued on behalf of, or in the interest of the aforementioned delegate, the undersigned will reimburse and indemnify the parties from any and all claims, damages, liabilities and expenses, including attorney’s fees.

______

Signature of Parent/Legal Guardian/Participant Printed Name of Parent/Legal Guardian/Participant

NC Youth Summit Photo Release

I hereby give permission to the 2013 Youth Rally Planning Committee to use photographs of me (or my child, if under 18) taken by the official photographer (s) for programs or promotions of said conference. I also recognize that these photographs are the property of the Triangle South Workforce Development Board’s Youth Rally Planning Committee.

______

Signatureof Parent/Legal Guardian/Participant Date

Youth Rally

Behavior Expectations

Good behavior is expected of all young adults at all times.

Participants are expected to attend workshops and general sessions during the entire rally.

Show respect to your fellow rally participants, staff, presenters and other guests.

No alcoholic beverages or any drugs are allowed at any time.

No smoking inside rooms, bathrooms or other facilitates.

No gambling.

No weapon of any kind is allowed at the Rally.

I agree to abide by all the rules and regulations set forth above, so that I may receive the maximum benefit from the 2013 Youth Rally.

Print Name: ______

Signature: ______

Date: ______

This is a smoke-free event.

Triangle South Workforce Development Area Youth Rally

REGISTRATION FORM INSTRUCTIONS

REALITY TV vs. the real world

REGISTRATION

Pre-registration forms are due no later than June 10, 2013. Young adults ages 14 -21 may participate in the Rally. All staff and youth must register; onsite registration will be available the day of the event. Contact Jackie McMillian for more information on the event at 919-777-7712.

Registration forms may be faxed to 919-718-4635-Attention: Ms. Geraldine Meadows or mailed to:Jackie McMillian, InterimYouth Program Coordinator, Triangle South WDB- 1105 Kelly Drive, Sanford, NC 27330.

CRITERIA FOR YOUTH RALLY PARTICIPATION

Ages 14-21*Parental Consent (if under 18)

Complete preliminary application for WIA Services if not currently enrolled

Available upon request by email:;

PAYMENT

We are happy to offer this fun-filled, empowerment driven Youth Rally to all local youth and youth program/ organizations free of charge!!To make arrangements for donations of door prizes or other giveaways, contact Jackie McMillian at 919-777-7712

STATEMENT OF COMMITMENT

All young adults who register must comply with this statement: I will make the necessary plans to attend the 2013 Youth Rally. If an emergency arises, I will contact my local agency or organization to notify them. As a young adult, I understand that I must attend all workshops and Rally activities and follow all Rally and facility rules. If I fail to follow the statement of commitment, I will be dismissed from attending other activities offered by the Triangle South Workforce Development Board.

Signature: ______

All staff or chaperones who register must comply with this statement: I will make the necessary plans to attend the 2013 Youth Rally. If an emergency arises, I will notify the Youth Rally Planning committee of the situation. As staff or a chaperone, I understand that I am responsible for ensuring that my young adults attend all workshops and rally activities and follow all rally and facility rules. If I fail to follow the statement of commitment, I will be dismissed from attending other activities offered by the Triangle South Workforce Development Board.

Signature: ______

Triangle South Workforce Development Board’s Youth Rally

REGISTRATION FORM INSTRUCTIONS

REALITY TV vs. the real world

CANCELLATION AND SUBSTITUTIONS

We reserve the right to cancel or postpone the 2013Youth Rally based on insufficient registrations. Registrants who cannot attend the rallyare expected to cancel by June 13, 2013. Substitution of a registrant merely requires written notification to: Jackie McMillian, Interim Youth Program Coordinator, Triangle South WDB- 1105 Kelly Drive, Sanford, NC 27330 or emailed to .

REGISTRATION DEADLINE

Early Registration will be accepted untilJune 10, 2013by 3:00pm. Please provide proof of identification, age, legal status, etc to expedite the registration process.

REASONABLE ACCOMMODATIONS

Every effort will be made to accommodate reasonable requests for special learning or dietary needs; however, we cannot guarantee provision for special needs unless notified more than 3 weeks in advance prior to the Rally. Please include special needs request with your registration form.

Event Information

Date: June 21, 2013 (Friday)

Time: 9:00am-4:00pm

Location: Dennis A. Wicker Civic Center

(1801 Nash Street,Sanford, NC 27330)

Equal Opportunity Employer/Program

Auxiliary aids and services to available upon request to individuals with disabilities

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