General Student Information This section should be completed by the student.
Student Name*
First
Last
Preferred Name*
This is for name tags. Please let us know if you go by a name other than the name above.
Student Date of Birth*
MM slash DD slash YYYY
Student Email Address*
Student Phone Number*
Street Address*
City*
State*
Zip Code*
What school do you attend?*
What is your T-Shirt size? (Adult sizes only)* Health & Emergency Contact Information Please complete this section with an adult.
Parent/Guardian Name (1)*
Parent/Guardian Phone (1)*
Parent/Guardian Email (1)*
Parent/Guardian Name (2)
Parent/Guardian Phone (2)
Parent/Guardian Email (2)
Emergency Contact Name*
(Must be someone not yet listed)
Emergency Contact Phone*
Food Allergies and Dietary Restrictions:*
We will provide meals and snacks for students during LU Summer Week.
Additional allergies and medical conditions we should be aware of:*
(Asthma, allergies, medications, etc.)
Insurance Card (Front)* Please upload the FRONT of your student's insurance card.
Insurance Card (Back)* Please upload the BACK of your student's insurance card.
Policies, Conduct, and Consent Please read carefully with an adult.
Read and Accept* By checking this box, I agree that I have read, and accept to honor my commitment to the Leadership U Program as outlined below.
I accept the commitment to participate in Leadership Howard County's 2026 Leadership U program. I understand that this commitment involves: Active participation and attendance in LU Sunday sessions; contribution/involvement in a community project; attending the (mandatory) LU Summer Week, Sunday, July 26 (4-7:30pm) & Monday, July 27 through Friday July 31 (8:30am-4:30pm) as well as the (mandatory) 3DHC Community Service Day (October 16 - When HCPSS schools are closed; students who do not attend HCPSS will coordinate separately).
Please note that students are allowed ONE absence during the Sunday sessions (August-December 2026); however, students are expected to communicate this in advance to their Team, Mentor, and Program Coordinator.
Any additional absences must have prior approval by the Program Coordinator. Refusal to follow this procedure may result in dismissal from the program.
Excused absences for the Sunday Sessions will be granted for:
- Illness (with a doctor's note), funerals, or at the discretion of the Program Coordinator.
The following are NOT acceptable excuses to miss LU meetings:
- Activities: School plays, musical or dance performances, college visits, or sports team activities
I understand that I will be asked to withdraw from the program should I not be able to attend LU Summer Week, or if I am unable to fulfill the attendance obligation to Leadership U. I understand that tuition is non-refundable should a participant not complete the program.
Read and Accept* By checking this box, I agree that I have read, and accept to honor my commitment to the Leadership U Program as outlined below.
I understand that proper behavior is expected and that the use of tobacco, tobacco/e-cigarette products, illegal drugs (including marijuana or prescription medications not prescribed to the participant) and alcohol is strictly prohibited while participating in any Leadership U activity, as is the possession and/or use of any dangerous weapons. It is also important that each parent/guardian and participant understand that even though we believe our experiential learning activities to be safe for persons in good health, there is some risk of injury, and accidents can occur.
Read and Accept* By checking this box, I agree that I have read, and accept to honor my commitment to the Leadership U Program as outlined below.
Each participant must agree that they shall not, at any time while attending Leadership U or while at any activity sponsored by Leadership Howard County, possess, use, consume, or distribute illegal drugs, tobacco, alcohol, and/or weapons. If an employee or other representative of Leadership U suspects that a participant is in possession of, under the influence of, or is using any of the above while participating in Leadership U activities, the participant will be expelled from the program and shall no longer be permitted to participate in any Leadership U activities. The participant’s parent(s) or guardian(s) shall be contacted by telephone or other means and required to pick up the participant immediately. Because of the inherently dangerous nature of the above materials, Leadership U reserves the right to act on reasonable suspicion and shall not be obligated to undertake any search of the participant. In the event the participant is expelled from the Leadership U program, any fee or tuition shall remain the property of Leadership U and shall not be refunded.
Read and Accept* By checking this box, I agree that I have read, and accept to honor my commitment to the Leadership U Program as outlined below.
Both the participant and their parent(s) or guardian(s) must understand that the class will be participating in modified “outward bound” or “ropes course” type activities and in other activities, including, but not limited to, athletic endeavors. All of these activities carry some risk, and while we believe them to be reasonably safe, injuries may result. By checking this box, you indicate that you know no physical reason why the participant should not be permitted to undertake such activities. You are also acknowledging that Leadership U does not carry health insurance for participants and that you, as parent or guardian, are assuming full responsibility for the risk of bodily injury, death, or property damage resulting from your child’s participation.
Should a participant be unable to perform the expected physical activities due to injury, disability, or other reasons, Leadership U will make every attempt to alter the expectations or provide substitute activities in order to accommodate the participant’s needs. Participants who have such physical restrictions, or the parents of such participants, should inform Leadership U with as much advance notice as possible so that accommodations can be considered.
If an injury occurs, Leadership U will attempt to contact a parent or guardian and will contact emergency medical services as it believes necessary. By signing below, you agree that Leadership and its officers, directors, and employees shall not be responsible for any damages resulting from an injury that the participant sustains while participating in Leadership U activities and that you will reimburse Leadership U for any expenses it incurs as a result of an injury to the participant, or as a result of any injury to any other person caused by the improper behavior of the participant.
Read and Accept* By checking this box, I agree that I have read, and accept to honor my commitment to the Leadership U Program as outlined below.
A core part of the program is to permit participants to discuss issues that are important to them and their community. These topics may be sensitive and controversial in nature. We wish to make you aware of this and ask for your consent, by checking this box, to allow your child to participate in these discussions. Please alert program leaders with as much advance notice as possible if your child, due to personal circumstances, will be unable to participate in the discussion of any particular topic.
Read and Accept* By checking this box, I agree that I have read, and accept to honor my commitment to the Leadership U Program as outlined below.
During the course of regular Leadership U activities, program staff, volunteers, or members of the press may take photographs, films, and videos of your child for use in promotional materials and local media. Your signature grants Leadership Howard County the irrevocable, royalty free, perpetual right and license use these photographs as seen fit.
Read and Accept* By checking this box, I agree that I have read, and accept to honor my commitment to the Leadership U Program as outlined below.
Prior to the start of LU, a schedule will be provided to the participants of the program and their families. This information will give parents the times and locations for dropping off and picking up their students. Leadership Howard County is not responsible for students traveling to and from sessions, nor do we have supervised childcare in the event that students are not picked up at the appropriate time. If, at any time, a student chooses to voluntarily leave while a session is in progress, Leadership Howard County is not liable for their safety at that time.
Read and Accept* By checking this box, I agree that I have read, and accept to honor my commitment to the Leadership U Program as outlined below.
Students are asked to maintain appropriate and respectful conduct during Leadership U. This is required at all times during our summer week, Sunday sessions, 3DHC, site visits, and any time students are representing Leadership Howard County at an event or activity. Leadership U students are role models in our community and are expected to behave accordingly, both during AND outside of Leadership U activities. Differing opinions from other participants, speakers, volunteers, or leaders are expected to be courteously and thoughtfully considered. All forms of media, including, but not limited to, text messages, emails, group chats, and social media accounts, such as Snapchat, Facebook, Twitter/X, and Instagram, should be used in a manner that reflects positively and respectfully on the program and others. Use of profanity or inappropriate language during the Leadership U program or on any such social media account is unacceptable, whether related or unrelated to Leadership U.
The main purpose of our program is to learn and have fun. It is important to have a respectful atmosphere and safe environment for all students. Should any student violate any standard of conduct, fail to comply with the behaviors addressed in this document or, in the opinion of a Leadership U staff member or volunteer, fail to maintain appropriate and respectful conduct, such student will be subject to discipline, suspension or removal from the Leadership U program. In this event, paid tuition and fees will not be refunded to the participant.
Read and Accept* By checking this box, I agree that I have read, and accept to honor my commitment to the Leadership U Program as outlined below.
Please be aware that Leadership U normally receives significantly more applications than there are available slots for participants. The acceptance of your child into the program means that another qualified student must be turned away. If your child accepts entrance into the program but later during the program opts to cease participation in the program for reasons within the participant’s control, no part of the paid tuition or fees will be refunded. Out of fairness to all applicants, acceptance into the program requires a commitment to complete the program in its entirety.
I understand and fully consent to this agreement. I understand that failure to comply with the above policies will result in removal from Leadership U, without refund.* Student Signature (type your full name)*
Parent/Guardian Signature (type your full name)*