Dream Out Loud

Name

First

Last

Address

Address Line 1

City

State

Zip Code

Phone

Email

Birth Date (month/day/year)

Please select how you identify

Female
Male
Non-binary
Prefer not to respond

Please select all that apply

If you are attending with a group, please write your group name (ex. Smith High School, Justice League Organization, LITE Leaders)

Do you have transportation to the event

Yes
No

Conference Kick-Off Special Guest and Breakfast 8:45 am – 9:55 am

Yes, I will be there

Dreamshops 10:00 am – 10:45 am

Arts & Culture – Painting project
Arts & Culture – Music
Health & Wellness

Dreamshops 10:50 am – 11:35 am

College & Career
Arts & Culture- Painting project
Arts & Culture – Music
Health & Wellness

Dreamshops 11:40 am – 12:05 pm

College & Career
Arts & Culture
Health & Wellness

Are you hungry? Lunch buffet 12:10 pm – 12:55 pm

Yes, I am hungry
No, I will not be eating

Do you have questions? Stay for Q&A 1:00 pm – 1:30 pm

Yes
Maybe
No, want to listen

Closing Activities 1:35 pm – 2:00 pm

Raffle prizes

Certification program sign up

Vendor tables

Consent for Promotional Purposes – permission to Leaders In Transformational Education (LITE) to use artwork, writing or pictures/videos taken at this event for the promotional purposes. I understand that refusal to sign this release will not affect delivery of service in any way. I am 18 years old or older/ I am a parent or guardian of a child under 18 years of age

Yes
No

Physical activity consent: I/my child does not have a medical condition that I am aware of that prevents me / my child from participating in this activity. I agree to hold Leaders In Transformational Education (LITE) and any of its officers, employees, or volunteers free from any and all liability and waive all claims of damages or recompense for any accident, injury or disability to me or my property arising out of or connected with my participation in this activity/outing. I also authorize the Chief Executive Officer of (LITE), or duly designated representative, to secure the necessary medical, hospital and surgical attention, in the event of illness or physical injury to me/ my child during participation in this activity. By providing your signature below you have read and agree to the statement above. If you are 18 years old or older pease sign in the space below If you are under age 18 please have a parent or legal guardian sign below

All participants must Sign: I understand and agree to any policies, notices, and procedure regarding transportation provided by my organization and that I must arrive with and leave with the same transporter. At no time will I leave an event with an unauthorized person. I / my child will stay with the group while at the event and be at designated pick up and drop off locations at the assigned time. I understand and do not hold any representative of (LITE) responsible for accidents or injuries in the event an unforeseen incident occurs and that me / my child agree to abide by the rules set for transporting. In the event the rules are not abide by, LITE may refuse to allow me / my child from participating in future off-site events. LITE will only provide transportation for LITE clients that are registered and active in LITE programming, If you are not a registered and active LITE client you / your child must secure your own transportation. If offered I agree to the above and give permission for me/ my child to take the transportation offered to the above mentioned event

We are excited that you will be joining us for the Dream Out Loud conference.

I would like to receive email updates regarding future conferences

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