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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 – firstname.lastname@example.org; 512.247.8476 Sharon Aguilar – email@example.com; 512.832.2620 Alida Garcia – firstname.lastname@example.org; 512.832.2513 Travis Head – email@example.com; 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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