iLead Law and leadership Conference Application

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DISCLAIMER
Please note that this application requires information and signatures from both the student and the students' parent/guardian. You will be allowed to save this application and come back to it at a later time.
iLead Law and Leadership Conference


JTB is holding two LLC's in 2018. The first on Friday, March 16, 2018 from 8:45am to 4:30pm in Baltimore, MD at University of Maryland Francis King Carey School of Law (500 W Baltimore St, Baltimore, MD 21201). The second on Saturday, March 31, 2018 from 8:45am to 4:30pm in Detroit, MI at Wayne State University Law School (471 W Palmer Ave, Detroit, MI 48202).

Applications are due by Friday, March 2, 2018 at 5:00 p.m. CST. Please note that applications will be accepted on a rolling basis until slots are filled. We encourage you to apply as soon as possible. 

Please indicate which iLLC you would like to apply for.

Student Information


















Student Demographic Information: The following questions will be saved anonymously and used for demographic purposes only.








Parent/Guardian Information





Optional Secondary Parent/Guardian Information





Optional Secondary Contact
OPTIONAL SECONDARY CONTACT: JTB-APO will send copies of program information to an additional email or mailing address of your choice.  Please include the email address of a teacher, coach or mentor who you would like to receive copies of important information.




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Program Information
Please confirm you have reviewed and understand the program requirements below.



Parent/Guardian: Photo Release and Informed Consent
Photo Release Form

In consideration for my child(ren) being permitted to participate in the Just The Beginning – A Pipeline Organization (JTB-APO) program or activity, I hereby grant permission to JTB-APO and each of its affiliated or subsidiary companies, their successors, agents, and assigns to utilize my child(ren)’s name, voice, and likeness (including, but not limited to, photographs and any video/audio recording of my child(ren)’s appearance at the program or activity) in any and all manner and media, now known or hereafter developed, throughout the universe in perpetuity without limitation and without additional compensation or consideration, notification, or permission, unless prohibited by applicable law.

I hereby waive any right that I or my child(ren) may have to inspect or approve any finished product (including, but not limited to, any blog, newsletters, brochures, videos, slide shows, websites, and/or other materials) or any advertising copy that may be used in connection therewith or the use to which it is applied. I hereby warrant that I have the right to make this release on behalf of my child(ren) and that my granting this waiver and release and the rights conveyed thereby will not infringe upon the rights of any third party. I hereby assign all rights, title, and interest my child(ren) or I may have in any and all media now known or hereafter developed in which any or all of my child(ren)’s appearance, name, voice, and/or likeness have been captured in connection with the program or activity to JTB-APO, along with full rights of assignability. I understand and agree that any photographs and/or video/audio recordings I make of my child(ren) at the JTB-APO program or activity shall be used solely for my and his/her/their private, noncommercial use, and that absolutely no sale, transmission, distribution, or commercial use of any such photographs and/or video/audio recordings or descriptions are permitted.

I have read and understand the above:




Informed Consent-Evaluation Participation

If your student is selected to participate in a Just The Beginning – A Pipeline Organization (JTB-APO) program.  As a routine part of all JTB-APO programs, students are asked to participate in an evaluation process that is integral to ensuring the program best meets the needs and interests of the young people that we serve.  As a parent or guardian, your consent is requested prior to the beginning of the program.  Students will be informed of the evaluation components of the program and will have the opportunity to choose not to participate based on their level of comfort.  There will be no negative consequences for students who choose not to participate or who discontinue their participation at any point.  The information gathered as part of the evaluation will be kept confidential and will not be utilized to evaluate or provide feedback to any specific student; rather the evaluation data as a whole will be analyzed to better understand the students’ experiences. By signing the form below, you are giving your consent for the student to participate in that evaluation process.

I represent that I have the authority to enter into this agreement on behalf of the student as the student’s parent or legal guardian.  





Parent/Guardian: General Release of Liability
General Release of Liability


FOOD ALLERGIES:  An environment free of allergens, including but not limited to food allergens, cannot be guaranteed by Just The Beginning – A Pipeline Organization (JTB-APO). While reasonable efforts will be made to serve food not containing known allergens as an ingredient, vendors may prepare meals in a facility that uses nuts, soy, wheat and other known allergens. Therefore, JTB-APO cannot guarantee that any particular food product is free of all traces of any particular allergen, that consumption of a food product will not result in some form of allergic reaction, or that the student will not come into contact with any allergens while participating in the JTB-APO programs.

 

The undersigned acknowledges and agrees that s/he is aware of such risks and that participation in the program will expose the student to food, activities and persons that may result in exposure to allergens and injury and, in that regard and assuming such risks, the undersigned hereby fully releases and discharges JTB-APO from any and all liability and/or responsibility to the student, the undersigned, or any third party for injuries to my child(ren), and/or any direct, indirect, punitive, incidental or any damages that arise out of or relate to student’s participation in JTB-APO programming and exposure to food allergens.

 

MEDICAL TREATMENT: In connection with any injury my child(ren) may sustain or illness or other medical conditions my child(ren) may experience during his/her/their participation in or attendance at the program, I authorize any emergency first aid, medication, medical treatment, or surgery deemed necessary by the attending medical personnel if I am not able to act on my child(ren)’s behalf. I agree to assume all liability for any expenses incurred in such an emergency (including, but not limited to, transportation, hospitalization and x-rays). I also understand and agree that JTB-APO will notify me if my child(ren) becomes ill during program hours, and I will arrange to have my child(ren) picked up immediately from the program. Further, I waive and release JTB-APO and its owners, officer, directors, employees, agents and independent contractors from any and all liability for personal injuries, illness, loss or damage to property.

 

PROGRAM POLICIES AND RULES: I understand and agree that my child(ren) must abide by the JTB-APO policies and rules and the instructions of the JTB-APO organizers, employees, staff and volunteers at all times, and that my child(ren)’s failure to do so will result in his/her/their immediate dismissal from the program.

 

ASSUMPTION OF RISK: I understand that my child(ren), and each participant in the JTB-APO program(s), will be engaging in activities that may involve the risk of serious personal injury, illness, permanent disability, dismemberment, and death, and that also involve the risk of severe economic and property loss and damage. I understand that these risks may result from the actions, negligence and failure to act of my child(ren) and others (including, but not limited to, other participants in JTB-APO program(s), and the organizers, employees, staff and volunteers, if any) and the condition of any real or personal property, facilities, or equipment used during the program.

 

I also understand that there may be risks involved in any and all activities which my child(ren) may participate which are not known to me, my child(ren), JTB-APO, or its organizers, directors, members, employees, staff, counselors, and volunteers, if any, and may not be foreseen or reasonably foreseeable by any of the foregoing entities or persons at this time or at the time of the program. For my child(ren) participating in a JTB-APO program, these activities and associated risks may include transportation via motorized vehicle (including, but not limited to shuttle, coach, and/or school bus) between different segments of the program during program hours. Permission is granted to JTB-APO to transport my child(ren) via motorized vehicle between different segments of the JTB-APO program to or from any outside facilities used by JTB-APO during the program. In consideration for my child(ren) being permitted to participate in the JTB-APO program, I, on behalf of my child(ren), assume all of the foregoing risks, including, but not limited to, the risk of any negligence by other participants or by JTB-APO, and its respective owners, partners, directors, officers, employees, and agents, and the risk of injury caused by the condition of any real or personal property, facilities, or equipment used during the program, and accept personal responsibility for any injury (including, but not limited to, personal injury, disability, dismemberment, and death), illness, damage, loss, claim, liability, or expense (including reasonable attorneys’ and professionals’ fees), of any kind or nature, that my child(ren) or I may suffer arising out of or in any way connected with the JTB-APO program or my child(ren)’s participation in or attendance at the JTB-APO program.

 

I REPRESENT THAT I HAVE THE AUTHORITY TO ENTER INTO THIS AGREEMENT ON BEHALF OF THE STUDENT AS THE STUDENT’S PARENT OR LEGAL GUARDIAN. I EXPRESSLY AND VOLUNTARILY ASSUME ANY AND ALL RISKS ASSOCIATED WITH PARTICIPATION IN JTB-APO PROGRAMMING. IN CONSIDERATION FOR THE STUDENT BEING PERMITTED TO ATTEND AND PARTICIPATE IN JTB-APO PROGRAMMING AND ANY AND ALL OF THE ACTIVITIES THAT ARE OR MIGHT BE ASSOCIATED WITH JTB-APO, ON THE STUDENT’S BEHALF, I RELEASE AND FURTHER AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS JTB-APO, INCLUDING ITS BOARD MEMBERS, MANAGERS, OFFICERS, OWNERS, STAFF, EMPLOYEES, AGENTS, CONTRACTORS, REPRESENTATIVES, VOLUNTEERS, INTERNS AND INSURERS, FROM ANY AND ALL CLAIMS, DEMANDS, ACTIONS, CAUSES OF ACTION, LAWSUITS, EXPENSES OR LOSSES (INCLUDING ATTORNEYS’ FEES) WHATSOEVER THAT COULD BE BROUGHT BY ME, THE PARTICIPANT OR A THIRD PARTY ACTING ON BEHALF OF THE PARTICIPANT OR ME FOR ACTS OR OMISSIONS RELATED IN ANY WAY TO, OR ARISING OUT OF, JTB-APO PROGRAMMING.