Thank you for deciding to enroll your student in the 2023 Illuminate Leadership Conference at Northern Kentucky University June 25 - June 30, 2023. We're thrilled to have your student be a part of this enriching opportunity.

Please thoroughly complete the forms provided in order to complete the registration process. Upon completion, you will be asked to submit your enrollment deposit via credit/debit card or PayPal.

We'll see you at the ILC!

 

Sincerely,

Illuminate Leadership Institute Team

Inspiring Bright Students!

STUDENT INFORMATION

Parent/Guardian Information (1)

Parent/Guardian Information (2)

Emergency Contact Information

GENERAL MEDICAL INFORMATION

The Illuminate Leadership Conference is designed with your student in mind. In order to ensure their safety, please complete the information below regarding dietary restrictions, medications, medical history, etc.

The Illuminate Leadership Institute and its staff do not pass judgement upon any student. We want to ensure that our staff is  equipped with the necessary knowledge/resources to ensure your student has an optimal learning experience.

Medications - “Medication” is any substance a person takes to maintain and/or improve their health. This includes vitamins & natural remedies. All medications (including over-the-counter medications) need to be in the original containers and must be turned in upon arrival at camp (except for inhalers) and accompanied by written instructions for staff.

This section should be completed if any of the aboved prescription medications are approved for self-administration. Self-carry is only permitted for emergency medical devices such as inhalers or epinephrine. The parent/guardian must consent to self-administration by signing below.

I consent that the child named above is able to self-administer the medication listed. I authorize self-administration of the above listed medication for the child named above under the supervision of an authorized operator/staff member. If indicated below, the child named above may self-carry emergency medication. I agree to release the Illuminate Leadership Conference, The Illuminate Leadership Institute and its agents from any and all liability arising as a result of this waiver.

MEDICAL HISTORY

PHOTO RELEASE FORM

With my signature below I GRANT PERMISSION for my child to be photographed/ videotaped, or their images recorded for print or electronic use in promoting The Illuminate Leadership Institute. I understand that it is my responsibility to update this form in the event that I no longer wish to authorize the above uses. I agree that this form will remain in effect during the term of my child’s enrollment. I understand that there will be no payment for me or my child’s participation in this release.

With my signature below I DO NOT GRANT PERMISSION for my child to be photographed/ videotaped, or their images recorded for print or electronic use in promoting The Illuminate Leadership Institute. I understand that it is my responsibility to update this form in the event that I no longer wish to authorize the above uses. I agree that this form will remain in effect during the term of my child’s enrollment. I understand that there will be no payment for me or my child’s participation in this release. 

PARTICIPANT CODE OF CONDUCT

As a participant in the Illuminate Leadership Conference, I will abide by the following code of conduct:

• I will conduct myself with dignity and respect for others and the property of others
• I will not bully any participants and understand there is zero tolerance for such behavior
• I will comply with all rules
• I will follow verbal directions of the staff. At no time will disrespectful attitudes by anyone be tolerated
• I will always keep my hands to myself  
• I will not take, hide or use other people’s possessions
• I will use appropriate language
• I will not bring any food or beverages in unauthorized areas on or off campus
• I will comply with the program dress code
• I will seek assistance from the staff with conflicts that arise
• I understand that I will be held financially responsible for any damage caused during the Conference

Prohibited Behavior:

I understand that at no times will the following be accepted:

• Use or possession of any illegal substance or paraphernalia (i.e. alcohol, drugs, tobacco)
• Destructive behavior
• Inappropriate or unruly behavior, including fighting or striking another member or staff member
• Inappropriate language (swearing or derogatory comments) or lying
• Stealing and vandalism
• Bullying or isolating another participant

Consequences for Violation of the Code of Conduct:

This code shall be in force for all participants during the Illuminate Leadership Conference. Disciplinary actions can range from, but are not limited to reprimands, behavior reports, being sent home from the program at the parents’ expense and expulsion from the program. If a participant is expelled from the program, a refund will not be administered and the student will not be invited back for future Illuminate Leadership Conferences.

FIELD TRIP PERMISSION FORM

My student has permission to participate in the field trips planned by the Illuminate Leadership Conference

Conduct During Excursions

I understand that my student’s participation in the activity is a privilege, and not a right. I acknowledge that I have spoken with my child about my child’s need to comply with the specific rules and requirements established for these activities; all program policies and procedures; rules of conduct set forth by the program and, state and federal regulations and laws. I understand that all program rules and policies apply to my student and the other students during the course of the field trip.

 

Transportation Permissions and Waiver of Liability

All students are expected to ride to the activity on Illuminate Leadership Conference provided transportation. I hereby understand that by signing this form I am releasing and discharging The Illuminate Leadership Institute and The Illuminate Leadership Conference, its/their officers, directors, agents, employees, chaperones, volunteers, successors, assigns and heirs, from any and all liabilities, suits, claims, demands, actions or damages (including attorney’s fees) incurred by me or by my child or are in any way related to or arising out of participation in the above event, including, without limitation, all claims for property damage, personal injuries or wrongful death, including any claims which allege negligent acts or omissions of or by The Illuminate Leadership Institute and The Illuminate Leadership Conference, its/their officers, directors, agents, employees, chaperones, volunteers, successors, assigns and heirs.

 

Medical Care

In consideration of permission granted to my student to participate in these activities, I hereby authorize the sponsor, in case of injury to said student, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care to be rendered to the minor under the supervision and advice of any physician or surgeon licensed to practice in the State of Kentucky or State of Ohio. I understand I will be notified of the injury at the earliest possible opportunity, but this authorization will allow treatment until I arrive. I also understand the expenses incurred from any such treatment will be my responsibility.

RELEASE OF LIABILITY

PAYMENT AGREEMENT

In order to provide your student with an all-inclusive experience, a registration fee is required, $900 for new scholars and $600 for alumni scholars. This includes room and board, conference materials,  and excursion fees. We offer a payment plan for those in need. All Final Payments are due by June 10, 2023.

TUITION PAYMENT

Hello Parent/Guardian,

We are so excited that your student will be joining us. Please complete the information below in order for us to hold your student's place. Remember all tuition payments are non-refundable. However, tuition is transferable. If your student cannot attend for some unfortunate reason, you can give their spot to another student who meets the requirements. All registrations are accepted on a first-come, first-served basis, and this program will reach capacity quickly.

Tuition covers: Room and board, conference materials, excursion fees, certificate of completion.