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					                                           C5 Youth Foundation of Texas
                                                  2nd Annual Leadership Summit
                                                     True Passion for Change
                                                           January 16, 2010

We are again kicking off the new year with our annual C5 Youth Leadership Summit! All classes are invited to
attend a powerful day of workshops and presentations designed to share how individual passions can transform
a community.

                                                    We expect every C5 youth to attend this year’s event.
                                                    For the first time in C5 history, we hope to bring together
                                                    all 300 C5 participants at once for a great day of learning
                                                    and celebrating being part of C5.

                                                    Please complete the Registration Form and Session
                                                    Selection sheet and return to C5 by December 21, 2009.
                                                    Due to transportation and workshop registration
                                                    arrangements, it is necessary that you RSVP by this date.
                                                    If, for some reason, you cannot return the form to us by
                                                    this date, please call so that we can make other
                                                    arrangements.


Mail or fax Registration Forms and Session Selection Sheets to:
              C5 Texas Office                                             fax to:
              c/o Rachel Jenkins                          OR              214.902.2801
              14185 Dallas Parkway Suite 1400
              Dallas, Texas 75264

Remember, registrations must be in the C5 Office by December 21, 2009.


If you have any questions, please contact:
        Fulori Kirikiti – fulorik@c5yf.org; 512.247.8476
        Sharon Aguilar – sharona@c5yf.org; 512.832.2620
        Alida Garcia – alidag@c5yf.org; 512.832.2513
        Travis Head – travish@c5yf.org; 512.832.2516




            We look forward to seeing you there!
                                                C5 Youth Foundation of Texas
                                                      2nd Annual Leadership Summit
                                                         True Passion for Change
                                                             January 16, 2010

                                        WHAT TO WEAR & WHAT TO BRING

All Leadership Summit participants must adhere to the business casual dress code.
       This includes:
              Slacks
              Khakis
              Skirts (knee-length or longer)
              Polos
              Button Down Shirts
              Dress Shoes
              Loafers
              Flats

       This does NOT include:
              Jeans
              Shorts
              T-Shirts
              Tank-tops
              Tennis Shoes (sorry, folks, this includes Vans and Converse)
              Flip Flops
              “Loud” makeup

All youth should also bring:
       Water Bottle
       Fall 2009 Grades


If you are traveling with us from DFW or Waco, you will be staying overnight at a local YMCA. As a result,
you should bring:
        Appropriate clothes for Saturday (see above)
        Sleeping Bag **no bedding will be available from C5**
        Pillow
        Toiletries (you will be able to shower)
                                               C5 Youth Foundation of Texas
                                                     2nd Annual Leadership Summit
                                                        True Passion for Change
                                                            January 16, 2010

                                               TRANSPORTATION OPTIONS


For youth coming from the DFW and Waco areas:
       Parent Drop Off:
             January 15, 2010
                     DFW:        6:00 pm –    Lamar Park and Ride
                                              1000 W. Lamar Blvd.
                                              Arlington, Texas 76012

                     Waco:         9:00 pm –      Texas Ranger Hall of Fame
                                                  100 Texas Ranger Trail
                                                  Waco, Texas 76706
       Parent Pick Up:
             January 16, 2010
                    DFW:           9:30 pm –      Lamar Park and Ride
                                                  1000 W. Lamar Blvd.
                                                  Arlington, Texas 76012

                     Waco:         7:30 pm –      Texas Ranger Hall of Fame
                                                  100 Texas Ranger Trail
                                                  Waco, Texas 76706


For youth coming from the Austin area:
       Parent Drop Off:
             January 16, 2010
                     8:30 am –      St. Edward’s University – Ragsdale Center
                                    3001 South Congress Avenue
                                    Austin, Texas 78704

       Parent Pick Up:
             January 16, 2010
                    5:15 pm –      St. Edward’s University – Ragsdale Center
                                   3001 South Congress Avenue
                                   Austin, Texas 78704
                                                  C5 Youth Foundation of Texas
                                                         2nd Annual Leadership Summit
                                                            True Passion for Change
                                                                January 16, 2010

                                                       Session Selection Guide

Use this guide to determine the sessions in which you are most interested. You will be able to select your top
three choices for each section on the Session Selection Sheet. These sessions will meet both in the morning and
in the afternoon.

       A: Students Taking Action for Respect (STAR)
              Students Taking Action for Respect is a student led, peer education organization that
              encourages students like you to make a difference in your school and community by
              preventing sexual and dating violence. The STAR program provides you with leadership
              skills and the knowledge to talk to your peers and to make positive changes in your
              schools and communities to defeat sexual and dating violence.

       B: Patrick Perez
               Patrick “Pac Man” Perez has danced to over 250,000 people across four countries. Using
               his passion for break dancing and youth, Patrick energetic success program focuses on a
               message of hope and perseverance that deals directly with drug and alcohol prevention,
               furthering one's education, drop out prevention, choices and goal-setting.

       C: Sarah Mullin
              On September 18, 2007, computer science professor Randy Pausch stepped in front of an
              audience of 400 people at Carnegie Mellon University to deliver a last lecture called
              “Really Achieving Your Childhood Dreams.” With slides of his CT scans beaming out to
              the audience, Randy told his audience about the cancer that was devouring his pancreas
              and that would claim his life in a less than a year. Sarah Mullin, M.Ed. will be exploring
              Dr. Pausch’s last message and will focus on the principles needed to achieve the dreams
              we all strive to make realities.

       D: Julie Petrus
               College. For some it’s still a while away, for others it’s just around the corner. Surveys
               show that life experiences contribute to academic skills, time management, goal focus,
               and self-advocacy. Julie Petrus, M.Ed., a college readiness counselor, will be helping
               students prepare for a successful college career through an interactive college readiness
               workshop.

       E. Hip Hop Congress
              The Hip Hop Congress uses the culture of Hip Hop to inspire young people to get
              involved in their communities through social action, civil service, and culture creativity.
              By educating children on the cultural and artistic elements in hip hop as an avenue for
              self-expression and creating a network of urban teachers interested in culturally relevant
              lessons and curricula, the Hip Hop Congress has given leaders the tools and support to
              make their vision a reality.
                                            C5 Youth Foundation of Texas
                                                   2nd Annual Leadership Summit
                                                      True Passion for Change
                                                          January 16, 2010

                                             Session Selection Guide, cont.



F. Zell Miller, III
Zell Miller, III’s unique blend of spoken word, hip hop and conscious music has made him a fast
rising star in the spoken word genre. His passion for hip hop, poetry, and theatre has changed his
community and has inspired youth around the country to share their messages and their lives. In
this session, Zell will work with youth to show the transformative power of the spoken word.

G. Texas Parks and Wildlife
If one of your favorite C5 memories includes the outdoors, then this session is for you! An
outdoor recreation career has many options, from game warden to park ranger, wildlife instructor
to researcher – and the leadership opportunities are endless. In this session, Joe Beach will share
his passion for the outdoors – and will help you explore ways to make your dreams a reality.

H. Hammers
From their unique perspective of being in the middle of their C5 experience, Hammers have
participated in big challenges in preparation for their upcoming collegiate careers. Through
reflection and goal setting, the Hammers have set high standards for themselves, and are using
their passion for their future to fuel their actions of today. Share in their experiences and learn
how to best transition from one year to the next.
                                               C5 Youth Foundation of Texas
                                                      2nd Annual Leadership Summit
                                                         True Passion for Change
                                                              January 16, 2010

                                                  YOUTH REGISTRATION

Youth Information
Name:
Address:
City:                                                       State:                      Zip:
E-Mail Address (youth):
Current School:                                                                         Grade:
Parent/Guardian Information
Name of adult(s) with whom this youth lives:

Relationship to youth:

Home Phone: (               )                              Work Phone: (            )
Cell Phone: (           )                                  Parent’s Email:
Additional Adult Contact: Please provide the name of another adult who can be contacted at a different phone number in
case of an emergency.
Name of the adult:
Relationship to youth:
Home Phone: (               )                              Work Phone: (            )
Cell Phone: (           )                                  Cell Phone #2: (             )


                                YES, my contact information has changed.
        Please indicate youth’s transportation option for January 15 (ONLY DFW or Waco)


                                    Lamar Blvd Park & Ride Facility (Arlington)
                                                     or
                                       Texas Rangers Hall of Fame (Waco)


                 **** Return Registration form By December 21, 2009 ****
                                              Mail to: Rachel Jenkins
                                           C5 Youth Foundation of Texas
                                          14185 Dallas Parkway, Suite 1400
                                                 Dallas, TX 75254
                                               Or Fax: 214.902.2801
                                  ACKNOWLEDGEMENT OF RISK
Youth’s Name:                                                         Date:

I, the undersigned, am the parent or Legal Guardian of the child named above who is to participate in C5 Texas
Pathways events during the school year of 2009-2010. I am aware that there are potential hazards and risks
involved in some programs. I willingly consent to my child’s participation in all aspects of the camp program
under the supervision of C5 Texas including field trips, adventure programs, backcountry wilderness travel
programs, and being transported in vehicles owned, leased, or arranged by C5 Youth Foundation Texas.


Signature of Parent or Legal Guardian:



                      ACKNOWLEDGEMENT OF RISK & CONSENT TO
                        PARTICIPATE IN ADVENTURE ACTIVITIES

   Your son or daughter will have the opportunity to participate in adventure activities including canoeing,
 caving, climbing, high ropes courses, and overnight backcountry travel. This portion must be signed to allow
      participation. Parents may call the camp office for more information about any of these activities.

As the parent or guardian of this young person, I am aware that during adventure activities in which my child is
participating under the arrangement of C5 Texas, certain dangers may occur. These include, but are not limited
to, traveling in rugged terrain; accidents or illness in remote areas with limited access to medical facilities; &
the forces of nature.

I acknowledge that there can be no guarantee of absolute safety against risk and unforeseen accident. I
understand that although C5 Texas has taken precautions to provide proper organization, supervision,
instruction, and equipment for each activity, it is impossible to guarantee absolute safety. I willingly give my
consent for my child to participate in adventure activities including canoeing, caving, climbing, high ropes
courses, and overnight backcountry travel.

I agree to hold harmless and indemnify C5 Youth Foundation, its’ Board of Trustees, and/or its’ employees,
agents, or lessors from any and all claims by myself, my heirs, my family, or my assigns.

I accept responsibility for verifying my child’s health and medical history and certify that he/she has no
physical or psychological problems that would prohibit participation in adventure activities.


I have carefully read this acknowledgement and sign this of my own free will.

Signature of Parent or Legal Guardian:




                                                  C5 Youth Foundation of Texas
                                         2nd Annual Leadership Summit
                                            True Passion for Change
                                                January 16, 2010

                                        Session Selection Sheet

Please mark your top three choices (with a 1 (for your first choice), 2 (for your second choice), and 3 (for your
third choice)) for both the morning and afternoon sessions.
Return this sheet (and your registration form) to:
        Mail: C5 Texas Office                       or               Fax: 214.902.2801
                c/o Rachel Jenkins
                14185 Dallas Parkway Suite 1400
                Dallas, Texas 75264

Morning Session:
       ___     A: Students Taking Action for Respect (STAR)
       ___     B: Patrick Perez
       ___     C: Sarah Mullin
       ___     D: Julie Petrus
       ___     E: Hip Hop Congress
       ___     F: Zell Miller, III
       ___     G: Texas Parks and Wildlife
       ___     H: Hammers


Afternoon Session:
       ___     A: Students Taking Action for Respect (STAR)
       ___     B: Patrick Perez
       ___     C: Sarah Mullin
       ___     D: Julie Petrus
       ___     E: Hip Hop Congress
       ___     F: Zell Miller, III
       ___     G: Texas Parks and Wildlife
       ___     H: Hammers




                 Your registration form and session selection sheet must be returned to the
                                C5 Office no later than December 21, 2009!

				
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