YOUTH SUMMIT APPLICATION FORM

YOUTH SUMMIT APPLICATION FORM
Youth Information
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Please enter a valid phone number.
Age *
Pronouns *
Grade in school (for coming year) *
School Name *
EMERGENCY CONTACT
Please provide one emergency contact over the age of 18 who are located in the State of Alaska. The phone number, address and relation to the youth is required. Applications will not be considered without this information.
Name *

First Name Last Name
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
LIABILITY CLAUSE
In case of accidental injury, psychological trauma, or death, I understand that Identity, Inc. will not be held liable . This release of liabiity extends to all Youth Leadership Summit activities including transportation. I understand that in the event of an emergency, Identity may be required to make an immediate decision regarding appropriate medical care.
Participant's Name *
Participant Signature *

Clear
Date

Month Day Year
Date
Parent/Guardian Name *
Parent/Guardian Signature *

Clear
Date *

Month Day Year
Date
MEDICAL INFORMATION
Medical and/or psychological conditions: *
Prescriptions (including name, dosage and purpose): *
Will any medications need to be given during the in-person portion of the Summit? (Friday 4:30pm to 7:30pm and Saturday 9am to 10pm)? If yes, the Youth Coordinator will reach out to the parent/guardian for specific information *

Yes No
Allergies (include reaction to allergy and proper care for allergy): *
Dietary Restrictions: *
Sexual Intimacy Policy
Identity, Inc. supports comprehensive sexual health education for youth. Many young people do not receive adequate education in their schools that speaks to the needs of LGBTQIA2S+ and allied youth. Sex between individuals should be safe, informed and consensual.

HOWEVER, sexual activity and intimacy between all participants at Identity sponsored events is absolutely prohibited in order to create a safe, respectful experience for everyone. We ask that you agree to not take part in sexual activity and intimacy while you are participating in the Summit.

Q: What is allowed under this policy:

A: People can engage in behavior that is consistent with friendship. That includes holding hands, walking close together, small kisses on the cheek when saying goodbye, talking to each other and spending free time together.

Q: What is NOT allowed:

A: Anything that goes beyond holding hands or having a conversation. Kissing on the lips, close physical contact (i.e. cuddling or spooning), or any activity that involves less articles of clothing that you would wear to school is not allowed. Public displays other than those listed are not allowed.
Behavior Policy
I agree to all of the following conditions of behavior during all 2022 Youth Summit related activites including transporation (as necessary):
- All people should be treated with respect at all times. Any form of harrassment or inappropriate behavior should be reported immediately to chaperones and/or Identity staff
- I will use appropriate pronouns and names. I will not make derogatory remarks about peoples' abilities, intelligence, race, ethnicity, class, color, gender identity or gender expression, sex, appearance or political beliefs
- I will remain at the event site and/or with the chaperones from Identity at all times
- I will not use alcohol, tobacco, or other drugs during summit-related activites and I will not bring alcohol, tobacco or other drugs with me to summit-related activities
- I will cooperate with all staff and abide by their decisions and directions
- I will be a representative of the summit by modeling positive behavior and respecting both my fellow participants and the facilities where summit events are being held
Consequences
I agree that if I violate this agreement I may be subject to any of the following consequences:
- Prohibited from participating in the remainder of the summit or being restricted from attending certain portions of the summit
- Become ineligible to participate in future Youth Leadership Summits sponsored by Identity
- Possible legal action if appropriate (for example, possession or use of alcohol/drugs, engaging in non-consenting sexual behavior or unwanted advances or sexual harrassment)
- Other consequences deemed appropriate by summit staff
- BEING SENT HOME IMMEDIATELY AT MY OWN COST WITHOUT THE RIGHT TO APPEAL
I acknowledge and understand both the Sexual Intimacy Policy and the Behavior Policy and understand that I am not to engage in any of the prohibited behaviors. I further understand the consequences listed above and that I agree to abide by the decisions of Identity summit staff.
Participant Signature: *

Clear
Date *

Month Day Year
Date
Parent/Guardian Signature: *

Clear
Date *

Month Day Year
Date
Media and Photo Release
As a participant of the Youth Leadership Summit, hosted by Identity, Inc. I, the undersigned, hereby authorize the right to reproduce my image, photograph or likeness, for publicity and fundraising purposes deemed appropriate. My photograph, image, likeness, interview and/or name may appear in either official materials - including, but not limited to, brochures, websites, email blasts, social media or any other form of media and/or technology currently in existence or not yet developed.

I authorize Identity, Inc. and any media outlet, either local and/or national, to reproduce my image, photograph, likeness, interview and/or recording. I understand that my pictures and/or interview may be accessible to anyone with internet accss and may appear in local, statewide, national and international print, internet, or television media. For instance, I understand that my picture may be published in my local newspaper where my family and friends can see.

I understand and accept that because of the nature of Identity's work as an organzation that fights homophobia and transphobia, I may be perceived as an out lesbian, gay, bisexual, transgender, queer or two-spirited youth.

I release Identity from any claims or liabilities that may result in the use of these photographs, images, recordings, interviews and/or likenesses.
Participant Signature *

Clear
Date *

Month Day Year
Date
Parent/Guardian Signature *

Clear
Date

Month Day Year
Date
Should be Empty:

YOUTH SUMMIT APPLICATION FORM

Youth Information

EMERGENCY CONTACT

LIABILITY CLAUSE

MEDICAL INFORMATION

Sexual Intimacy Policy

Behavior Policy

Consequences

Media and Photo Release