Download Unified for Uganda Summit 2016: The Power of One June 3

 Unified for Uganda
Summit 2016:
The Power of One
June 3 - 5, 2016
Unified for Uganda invites you to our ​
Leadership Summit: The Power of One.​
You will have the opportunity to interact with local, national, and global peacekeepers. You will receive formal leadership training, learn about the vision of U4U`s future, visit a culture fair to dive deep into Acholi culture, and of course there are a few surprises we can’t reveal! So please join us for an incredible experience you will never forget. What is Unified for Uganda?
Unified for Uganda is a nonprofit organization that financially and emotionally supports the education of destitute children in northern Uganda through the empowerment of global youth. There are currently 40+ chapters of Unified for Uganda in high schools and colleges throughout the Eastern United States. Hundreds of students are working to support the youth of Gulu, Uganda, both financially and emotionally through fund raising, letter writing and visiting the schools. All funds raised for sponsorship go directly to support the education of your sponsored child. We have direct contact via email, Skype, and phone with our 3 Mentors and Program Director on the ground in Gulu! Visit our website for more info: www.unifiedforuganda.com EVENT DETAILS
Check­in for attendees is from 4:30­5:30 on Friday, June 3rd. ​
Thanks to a grant from The Mayerson Foundation, the cost of attending the event is $70, which includes room in a Xavier dorm, meals, a summit t­shirt, and the cost of the summit itself. What to Bring
Pack for the weekend! Comfortable clothing is best. The conference is in June, but it could be chilly at night so be prepared. Linens are provided by Xavier University, but feel free to bring your own if you wish. Snacks and a water bottle are both good ideas to keep you going between meals. Your cell phone and a journal/notebook with a pen are a must! Lastly, bring an open mind and a willingness to learn, and we promise you a transformational experience. How to Register
You have to options for registration: ­
New this year…​
Online registration!​
Visit ​
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www.unifiedforuganda.com/summit​
to complete the form and pay the non­refundable registration fee with a credit card. If you plan to register online, your registration fee will be slighter more to cover the cost of processing. OR ­ Old School Registration!​
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Not so technically inclined? Don’t sweat it! You can go old school and print out this registration form. Fill out this form and drop it in the mail with a nonrefundable check for $70 made out to Unified for Uganda PO Box 42177 Cincinnati, Ohio 45242 Thanks to grants from various sponsors, we have a limited number of ​
need­based ​
scholarships to attend the Summit. If the funding for the Summit is an issue, please send an email to [email protected]​
before sending in your application!! Any questions or concerns, please contact Connie Ring, U4U Director of US Operations at [email protected] 513.260.3054 Registration Deadline: March 31, 2016 Unified for Uganda 2016 Leadership Summit Registration Form for Students Under Age 18 Student’s Name: _________________________________ Age: ________Gender: _________ Email: ___________________________________________Cell: _________________________ School: __________________________________________Tshirt Size: S M L XL XXL I request that my son/daughter ________________________ be permitted to participate in Unified for Uganda’s 2016 Leadership Summit: The Power of One. The event is June 3­5, 2016, from 4:30pm Friday to 12:00pm Sunday at Xavier University. I understand that my child will stay on the dorms on campus and will share a room and bathroom with 3 other people of similar age and same gender. This is an alcohol and drug free event.​
I understand that security in the form of approved adult chaperons, Xavier Campus Police and/or Cincinnati City Police will be present at all times during the event. Upon arrival I understand that my child’s bags may be randomly searched by proper authorities in an effort to keep the event drug and alcohol free. I understand that my signature on this form signifies my approval of these arrangements. RELEASE AND INDEMNIFICATION AGREEMENT AND MEDICAL POWER OF ATTORNEY 1. I, the lawful parent or guardian of ________________________________ (The “child”) release from all liability, and indemnity and hold harmless Unified for Uganda, the Directors and Officers of Unified for Uganda, all volunteers and chaperones of the Unified for Uganda Leadership Summit (“the event”), and officers, agents, representatives, volunteers, and employees of Unified for Uganda or participating schools thereof (“agents”) from any and all liability, actions, causes of action, claims, judgments, cost of expenses, including attorney fees, known or unknown at this time, arising out of or in any way related to any injury or illness incurred by my child while participating in or traveling to or from the activities in the event. 2. I agree to instruct my child to cooperate with Unified for Uganda or its agents in charge of the event. 3. In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by ____________________________, doctor, or ___________________________________, dentist, or in the event the designated preferred practitioner is not available, by another licensed physician or dentist; and (2) the transfer of the child to any hospital reasonably accessible. Preferred local hospital: __________________________________________________. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity of such surgery, are obtained prior to the performance of such surgery. 4. I also agree to the following: The posers of authority granted herein may be revoked by me by written notice delivered to Unified for Uganda or its agents who are then acting or who have previously acted hereunder. Without such written notice, this power of attorney shall not be affected by my disability, incapacity or adjudicated incompetence. This power of attorney shall lapse automatically upon completion of the event and the return of my child to the Ending Place. 5. I agree that Unified for Uganda or its agents may use my child’s portrait, photograph, and/or video for editorial and office functions, in print and/or on the internet and hereby release Unified for Uganda and its agents from any liability resulting from such use. I have carefully read this statement, and my signature acknowledges that I understand its content and meaning. Student Signature __________________________________________ Date _____________ Parent Signature __________________________________________ Date _______________ (if student is under 18) Phone (H) _______________________ (C) __________________________________ Address ________________________________________________________________ City ___________________________________________ Zip _____________ Emergency Contact (other than parent) _______________________________________ Relationship to child ________________________ Phone ________________________ MEDICAL INFORMATION Birthdate __________________ ​
Allergies ________________________________________________ Medications ______________________________________________________________________ Medication Insurance Co. ___________________ Members Name _________________________ Family Doctor ____________________________ Phone ___________________________ Your Leadership Style Directions: The focus of this survey is toward your typical behavior. Respond based on how you most naturally behave. Rate each row of words from left to right on a 4, 3, 2, 1 scale with 4 being the word that BEST describes you and 1 being the word that LEAST describes you. Use all ratings on each row (ie 1, 2, 3, 4) and use each rating only once per row. Answer based solely on your instinctive behavior, whether you think it is good or bad. After ranking the words in each row 1 through 4, add the numbers in each column and record the total for each column where indicated at the bottom of each column. Column A Column B Column C Column D Persuading Commanding Decisive Tough Minded Independent Daring Risk Taker Courageous Confident Fearless Non­Conforming Assertive Take Charge Aggressive Loud Peaceful Negotiating Enthusiastic Patient Detailed Expressive Lenient Particular Convincing Kind Fun Loving Loyal People oriented Understanding High Standards Serious Meticulous Follows Rules Lively Charitable Cheerful Merciful Inspiring Supportive Good Mixer Quiet Talkative Even Paced Analytical Popular Good Listener Organized Uninhibited Cooperative Tactical Vibrant Gracious Accurate Precise Logical Conscientio
us Direct Excitable Accommodating Frank Influencing Peaceful Focus Forceful Animated Agreeable Systematic Total = Total = Total = Total = Efficient Note: The sum of the four columns should total 170 points. If it does not, then re­total each column.