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Foundations of Leadership Application

Foundations of Leadership Conference Application

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Personal Information

First Name (to appear on name tag)*:
Last Name*:
Mailing Address*:

City*:
State*:
Zip/Postal Code*:
Country (if not United States):
Primary Phone*:
Email Address*:	* (Valid Email Required)
Age*:
Gender*:
T-Shirt Size*:
Date of Birth*:
Please provide a recent photo of you*:

Participant Information

Please answer the following:

What are your current interests and hobbies?* Limit of 120 characters!
What are you planning on studying at BYU?* Limit of 120 characters!
Where will you be living at BYU?*
What are some of your concerns about college life?* Limit of 120 characters!
What do you hope to gain from attending the Foundations of Leadership Conference?* Limit of 120 characters!

Inform us about your involvement in high school. Please check all that apply.

	Student Council
	National Honor Society
	DECA
	FBLA
	FCCLA
	Drama
	Link Crew
	High School Athletics
	Band
	Choir
	Model United Nations
	Boys State / Girls State
	Boy Scouts of America
	Religious organization(s)
Other (i.e. service, community, work-related, etc.)

Participant Insurance Information. This information will be kept confidential.

Student Full Name*:
BYU Net ID (Route Y login)*:
Insurance Provider*:
Policy Number*:
Do you have any special needs? If yes, please explain: (i.e. allergies, medical conditions, dietary, etc.) Limit of 120 characters!

Financial Aid

	Please check here if you are in need of financial aid in order to attend the conference

Consent and Agreement Information

By typing your name, you are effectively entering your signature.

Assumption of Risk, Release, and Indemnity Agreement This is a legally-binding agreement made by me with Brigham Young University. I fully recognize that there are potential dangers and risks to which I may be exposed by participating in the 2008 Foundations of Leadership Conference. These dangers and risk include, but are not limited to, personal injury or death arising from transportation associated with the conference and/or participation in strenuous activities at high altitude or on rough terrain and other dangers and risks inherent in any activities or programs which I elect to participate in at the conference. I further understand that Brigham Young University does not require me to participate in these activities, but I want to do so, despite the possible dangers and risks and despite the rights I am waiving by signing this Agreement. I, therefore, agree to assume and take upon myself all the risks and responsibilities in any way connected with these activities and transportation associated with it. In consideration of and return for being allowed by Brigham Young University to participate in these activities, I release and agree to indemnify BYU (and its governing board, employees, and agents) from any and all liability, claims, and actions that may arise from injury or harm to me, from my death or from damage to my property in connection with these activities. I understand that this Agreement covers liability, claims and actions caused entirely or in part by any act or failure to act of BYU (or its governing board, employees, or agents), including but not limited to negligence, mistake, or failure to supervise by BYU. I recognize that this Agreement means I am giving up, among other things, rights to sue BYU, its governing board, employees, and agents for injuries, damages, or losses I may incur. I also understand that this Agreement will be construed in accordance with the laws or the State of Utah and that binds my heirs, executors, administrators, and assigns, as well as myself. I understand and represent that I have no health-or injury-related conditions (recent or chronic) which will be aggravated by or which will limit or exclude active participation in the conference. In the event any illness or injury occurs during participation in the conference, I give permission for those affiliated with the conference to provide me with the immediate first aid and to transport me to the nearest Urgent Care facility to receive medical treatment; and I agree to be financially responsible for all expenses incurred in such transportation and treatment.
	Agree to the Assumption of Risk, Release, and Indemnity Agreement*

Parent/Guardian Consent*:
Date of Consent:
Applicant Consent*:
Date of Consent:


and proceed to payment

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