Future Leaders Programme: Summer Registration 2023

Future Leaders Programme

Summer Registration 2023

Sponsored by:

______________________________________________

The Future Leaders Programme is a service-learning experience tailored to challenging young budding leaders ages 13 - 17 who have a sincere interest in learning about service, activism, socio-political issues, and leadership in Bermuda. Students must be willing to be challenged academically and socially as they learn about issues affecting the community, talk with leading government officials, business professionals, top community leaders and citizens, and engage in community service projects throughout the island.

If accepted, a confirmation email will be sent with further information shortly thereafter.

NOTE ON REGISTRATION:

Parents/Guardians and Students alike are expected to be fully engaged throughout the duration of the programme. Acceptance is not guaranteed.

Due to limited space, incoming applications may be placed on a waiting list (unless the student has received a nomination letter from school). We aim to confirm all places by June 2023.

Fees:

No charge - The programme fees of $225.00 per week are being sponsored by the Government of Bermuda. Students must commit to the full three-week programme from July 3 - 21. All learning materials and a programme t-shirt are included. Confirmation is required via email in order to complete the registration process.

Deadlines:

General Registration opens May 17th.

All confirmations given by June.

Programme start date: July 3rd 2023.

Applicant Information

Student's Name*

First NameLast Name

Sex:*

MaleFemale

Birth Date*

DayMonthYear

Current Age:*

School:*

T-Shirt Size*

Grade Level (2022-23 School Year)*

Home Address*

Street Address

Street Address Line 2

Parish

Postal CodeCountry

Student's email address

example@example.com

Parent/Guardian Information

Adult Name*

First NameLast Name

Relationship to child:*

Home Number*

Area CodePhone Number

Cell Number*

Area CodePhone Number

E-mail Address where you'd like to receive confirmation and information:*

example@example.com

Additional email address (optional)

example@example.com

Has the student received an individual nomination letter from their school?*

No, I am registering on my ownYes, student has received individual letter from school

Is there anything else we should know about the student in considering their acceptance into the Programme?

Emergency/Medical Information

Emergency Contact (Adult 2) Name:*

First NameLast Name

Relationship to child:*

Day Phone Number:*

Area CodePhone Number

Alt. Phone Number:*

Area CodePhone Number

Does the student have any allergies, chronic illness, medical conditions and or physical limitations? (If yes, please describe.)

Is the student prescribed an inhaler or any medications: (If yes, please explain any instructions)

Legal Stuff

Informed Consent and Acknowledgement

I, as the parent or legal guardian of the named student ('child'), do hereby grant permission for my child's participation in any and all activities prepared or facilitated by the Future Leaders Programme (the 'Programme'). In exchange for the acceptance of said child's candidacy by the Programme, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the Programme and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected Programme sessions and activities. I understand that in the course of studying issues such as gang violence, poverty, etc. and as part of the Programme, my child will undertake field trips which may include physical activity or the entering of environments to which they may or may not be normally accustomed. I also understand that the challenges presented by the Covid-19 pandemic may present a unique risk to my child's safety when participating in group or in-person experiences with persons outside of their household, and have also accepted and included this in absolving the Programme of these risks as stated above. Every reasonable precaution will be taken to ensure my child's safety to the best of the ability of every staff member of the Programme.

I am fully aware, consent to, and accept these risks and voluntarily agree to allow my child's participation in all activities facilitated by the Programme.

Medical Release and Authorisation

As Parent and/or Guardian of the named student ('child'), I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is also granted to the Programme and its affiliates including Directors, Teachers, and Staff to provide the needed emergency treatment prior to my child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the safety of the named minor child, in my absence.

Photo Release

I furthermore understand that the photographs or videos of my child may be taken throughout the duration of the Programme. I grant permission without compensation that these photographs or videos may be used in publications, presentations, websites or promotion of the Programme.

Electronic Signature: By entering my name below, I accept the above conditions and releases. (You must be the legal parent or guardian of the child and 18 years old or over to sign.)*

First NameLast Name

Signature*

Relationship to child:*

Current Date:*

Date

BY ACKNOWLEDGING AND CLICKING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

For questions or help, email info@futureleaders.bm.