• Youth participants must be CURRENT middle or high school students.
    To ensure that the Indiana Black Expo, Inc. (IBE) Youth Leadership Summit (YLS) is a positive and enjoyable growth experience for all attendees, it is necessary to establish and enforce the highest standards of positive behavior. Please be sure to review these behavior standards.

    1. All delegates and chaperones must attend all general sessions and seminars.
    2. Delegates must be in the hotel and in their rooms by curfew unless the IBE Youth Leadership Summit Planning Committee announces a change in schedule.
    3. Co-ed visitation in rooms is STRICTLY PROHIBITED.
    4. All delegates and chaperones are prohibited from using alcohol, tobacco products, or drugs.
    5. Delegates and chaperones must show courtesy and respect for others at all times. Fighting, gender harassment, sexual misconduct or the use of profanity will not be tolerated.
    6. Delegates must maintain a reasonable and moderate noise level at all times.
    7. Delegates must dress appropriately at all times. Shirts will be provided to wear on Saturday
    8. To aid in identification, all delegates and chaperones must wear name tags at all times. In addition, IBE Youth Leadership Summit t-shirts are to be worn in the Indiana Convention Center at all times.
    9. Delegates and their parents are responsible for any expenses that arise as a result of damages to hotel property.
    10. IBE is not responsible for items lost or stolen. Delegates should refrain from bringing valuable items to the conference.

    IBE Youth Leadership Summit (YLS) chaperone expectations:
    ■ All youth attending the summit must be accompanied by a chaperone that is at least 25 years of age.
    ■ Agree with the Mission Statement and Goals of IBE YLS.
    ■ Be screened, complete a background check, and be given appropriate orientation prior to the YLS conference.
    ■ Fully complete online Registration form, Medical Waiver, Release form, and Code of Conduct Form.
    ■ Supervise and be responsible for the youth entrusted to their care for the entire YLS conference; and
    ■ Work with IBE YLS Staff and Volunteers to handle any code of conduct violations concerning their youth.
    ■ DO NOT bring any unregistered individual to the summit.
    ■ IBE will not be responsible for, nor provide credentials, tickets, t-shirts, meals or supplies to individuals that are not registered.
    ■ Must join on all scheduled conference calls prior to YLS to prepare your attendees prior to their arrival.
    ■Remain on site with the students they chaperone.
    I understand that this registration is effective on the date in which it is submitted and cannot be changed after June 28, 2019.
  • Application Section

    You are moving into the application section of the form, please make sure you have the following document ready for uploading:
    * Fall 2018 School Transcript
    * Recommendation Forms
  • Please do not enter 0's or other numbers this need to be a REAL number
  • If so, please explain below.
  • Chaperones list N/A
  • Drop files here or
  • List the name of the group or organization you are attending with, i.e., FSSA South Bend. If none list N/A.
  • Chaperones are registered attendees. If you do not have a chaperone list 'please assign"
  • Please do not enter 0's or other numbers this needs to be a REAL number
  • Please check with your school counselor and provide your GPA based on a 4.0 GPA scale. An official transcript must be uploaded below.
  • If you are a chaperone enter 999-999-9999
  • If you are a chaperone enter 999-999-9999
  • If none put N/A.
    I will make sure my child has any prescription medication that has been prescribed to him/her with them for the YLS activities. Example: If your child has an inhaler for asthma, they MUST bring it with them for the weekend. Please select N/A if your child does not have any prescription medication.
  • Please do not enter N/A or other letters this needs to be a REAL information
  • Please do not enter 0's or other numbers this needs to be a REAL information
  • Please do not enter N/A or other letters this need to be a REAL information
  • Please do not enter 0's or other numbers this needs to be a REAL information
    MEDICAL WAIVER & MEDIA RELEASE FORM This is a waiver and media release of liability and indemnification for Indiana Black Expo, Inc. and of its sponsors, partners, venues and their owners. Being a parent or legal guardian (both referred to herein of the registrant and not being an employee of the Parties nor any individual Party, desire for my Child to participate in all activities included as a part of the IBE Youth Summit & Summer Celebration and specifically, by his/her participation in physical endeavors ("Activities") offered or hosted during the IBE Summer Celebration July 19-21, 2019. I fully understand the risks involved and that it is possible for my child to sustain serious injury, permanent disability and/or death during the course of said Activities. However, in partial consideration of the opportunity for my Child to participate in the Activities, I individually and for my Child covenant not to sue and forever discharge the Parties, their respective venues, vendors, sponsors, subcontractors, volunteer, agents, partners, officers, directors, employees, trainers, physicians, licensees, lenders, subsidiaries, representatives, shareholders, agents, insurers, successors, and assigns (hereinafter collectively known as "Releasees") from any and all liability to the undersigned, my Child, my Child's other Parent, personal representatives, assigns, heirs and next of kin for any and all loss and damage, and any claim or demands therefore on the account of any injury, illness or death suffered by my Child in connection with the Activities, whether caused by sole or concurrent negligence of Releasees or otherwise. I, individually and for my Child and my Child's other Parent, further do hereby indemnify and hold harmless said Releasees against any and all losses, and/or expenses (including but not limited to legal fees) that they may incur as a result of claims made as a result of my Child's participation in the Activities. I also hereby give my permission for IBE to collaborate with my child's school system, in securing copies of grades, attendance, discipline referral, suspension information, and school counselor's reports, to help IBE staff support my child's educational process. My child may also participate in prevention, intervention, and recreational programs which is focused on assisting youth with saying NO to drugs and making positive and healthy decisions. These programs will ask my child if he/she would like to participate in voluntary surveys. My child's name will NOT be used on surveys! I hereby give Indiana Black Expo, Inc., permission to use and authorize others (media outlets) to use all or any part of my (his/her) interview/photograph/video in IBE related media such as books, magazines, journals, pamphlets, electronic (Internet) and other written and video formats, regardless of the medium by which it is recorded. I warrant and represent that I have been authorized by my Child's other Parent to execute this release for my Child's other Parent. I HAVE READ THE ABOVE WAIVER AND RELEASE AND INDEMNIFICATION AND FULLY UNDERSTAND ITS CONTENT.