Student Leadership Conference: Registration

First Name *

Last Name *

Nickname

Student or Adult Sponsor *

Fall 2022-23 Grade *

School Name *

Street Address

City

Postal Code

State/Province

Phone Number *

Email *

Any allergies and/or dietary restrictions? *

Yes

No

List all allergies and/or dietary restrictions *

List all prescriptive medications you may be taking while attending the Conference

Photo permissions *

I give my permission for the Ursuline Education Network to use my photograph and name in publication, website, video, brochure, or any promotional material produced by UEN, Ursuline College of Cleveland or other participating schools as distributed to the media.

Yes

No

Student Agreement *

I understand the expectations and responsibilities that come with my involvement in the Ursuline Education Student Leadership Conference. This program, while entirely voluntary, represents an extension of my school and demands a level of commitment that must be maintained and upheld throughout the Conference. I understand violation of behavior rules and regulations will result in my dismissal from the Conference at my parent’s/guardian's expense.

Yes

No

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