Youth Leadership Institute Youth Registration Form

Alpha Kappa Alpha Sorority, Incorporated ®Youth Leadership Institute (YLI) Summit Saturday, May 31, 2025

Registration and Guardian Permission Form
Youth Name *

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age*
Gender *
School *
Grade*
Food Allergies *
How did you hear about Youth Leadership Institute? *
Gender*
School *
Grade*
Food Allergies
How did you hear about Youth Leadership Institute? *
example@example.com
Parental/Guardian Permission for Minor to Participate in Youth Leadership Institute
I permit my child to participate in the Youth Leadership Institute Summit, which is scheduled for Saturday, May 31, 2025, at the University of Minnesota Urban Research and Outreach-Engagement Center (UROC).

I acknowledge that my child will be supervised by Alpha Kappa Alpha Sorority, Incorporated ®, Delta Phi Omega Chapter during the event.

I agree to hold Alpha Kappa Alpha Sorority, Incorporated ®, Delta Phi Omega Chapter, and its volunteers harmless from any liability that may arise from my child's participation in this event. I understand that my child will be expected to abide by the rules and regulations set forth by the event organizers and that failure to do so may result in removal from the event.
Signature*

Clear
Photo Release
I hereby grant permission to Alpha Kappa Alpha Sorority, Incorporated ®, Delta Phi Omega Chapter to use photographs and/or video footage taken of my child on Saturday, May 31, 2025, at the Youth Leadership Institue Summit held at the University of Minnesota Urban Research and Outreach-Engagement Center (UROC).

I understand that these images may be used in promotional materials, social media, publications, or any other media for marketing and publicizing the activities and programs of Alpha Kappa Alpha Sorority, Incorporated ®, Delta Phi Omega Chapter.

By signing this release, I understand this permission signifies that photographic or video recordings of my child may be electronically displayed via the internet or in the public educational setting.

I hereby release any claims against Alpha Kappa Alpha Sorority, Incorporated ® utilizing material for the above-mentioned purposes.
Signature

Clear
Emergency Contact Information
Parent/Guardian Name*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Alternative Emergency Contact Name *
Phone Number*
Please enter a valid phone number.
Parent/Guardian Name *
example@example.com
Phone Number *
example@example.com
Alternative Emergency Contact Name *
example@example.com
Phone Number *
example@example.com
Should be Empty:

Alpha Kappa Alpha Sorority, Incorporated ®Youth Leadership Institute (YLI) Summit Saturday, May 31, 2025

Parental/Guardian Permission for Minor to Participate in Youth Leadership Institute

Photo Release

Emergency Contact Information