Event Registration

Youth Pride Conference 2023

Let's Get Loud!

Let’s Get Loud! Register for this year’s Youth Pride Conference for a day of fun, live entertainment, educational sessions, and more. Be inspired by voices in the LGBTQ community; be empowered to live your life authentically; make connections that could last a lifetime.

PLEASE AGREE TO THE STATEMENT ABOVE TO CONTINUE.

Participant First Name *

Participant Last Name *

Pronouns *

Current School *

Grade Level *

Email *

Phone *

Select *

Do you have food allergies or dietary restrictions? *YesNo

If applicable, enter dietary restrictions here

Will you need transportation to the event on March 25, 2023? *YesNoGLSEN Collier County will provide transportation to and from the event from various locations through Collier Collier and south Lee County. Pick-up locations and times are subject to change based on needs of students who pre-register. A chaperone will accompany students on all transportation provided.

Pick up locations *Near Immokalee Middle School and Immokalee High School (pick-up at 7:50 am, drop-off 4:05 pm)Near Corkscrew Middle School and Palmetto Ridge High School (pick-up at 8:10 am, drop-off at 3:45 pm)Near Manatee Middle School and Lely High School (pick-up at 8:15 am, drop-off at 3:40 pm)Near Golden Gate Middle School and Golden Gate High School (pick-up at 8:25 am, drop-off at 3:30 pm)Near Estero High School in Lee County (pick-up at 8:10 am, drop-off at 3:45 pm)Exact locations, times TBD and subject to change based on demand. Details will be confirmed with each participant one week prior to the event.

Permission to Attend

Youth Pride Conference | Saturday, March 25, 2023. 5200 Crayton Road, Naples, FL 34103

Rules of Conduct

GLSEN Collier County General Rules of Conduct
While attending the Youth Pride Conference, participants agree to abide by the following rules:

❑ Participants are asked to be respectful of all other participants and staff;
❑ Participants are prohibited from using, possessing, or arriving under the influence of drugs or alcohol;
❑ Participants agree not to engage in any illegal activity whatsoever;
❑ Participants agree not to engage in any sexualized behavior (including inappropriate touching or comments);
❑ Participants who leave the event site prior to the conclusion of the event will not be permitted to re-enter;
❑ Participants will help ensure the safety of all participants by immediately alerting staff to any health or safety issues or any activities that violate the general rules or otherwise compromise the safety or well-being of any participant;
❑ Participants are not to record at any time while in attendance at the conference (including but not limited to sound recordings, pictures, or videos);
❑ GLSEN Collier County reserves the right to request the removal of any attendee that fails to comply with these rules of conduct.

Participant Statement of Consent

I agree to abide by the GLSEN Collier County General Rules of Conduct provided above at all times while in attendance at the Youth Pride Conference on March 25, 2023 at 5200 Crayton Road, Naples, FL 34103. I understand that violation of this agreement may result in expulsion from the event.

Participant First and Last Name *

Participant Signature *

Date *

Parent/Guardian Statement of Consent

It is understood and agreed upon by the participant and parent/legal guardian that all participants will abide by the GLSEN Collier County General Rules of Conduct. I understand that violation of this agreement may result in expulsion from the event. I hereby give my consent for my child to attend the Youth Pride Conference on March 25, 2023, at 5200 Crayton Road, Naples, FL 34103

Parent/Guardian First and Last Name *

Parent/Guardian Phone Number *

Parent/Guardian Signature *

Date *

Medical Release Form with Emergency Information

Youth Pride Conference | Saturday, March 25, 2023. 5200 Crayton Road, Naples, FL 34103

The following medical information about this participant is for the purpose of obtaining immediate medical attention if necessary and is to be completed by all participants and parent(s)/legal guardian(s) of participants younger than 18 years old. Please provide as much information as possible to ensure the health and safety of participants in attendance.

Participant's Legal Name *

Date of Birth *

Month

Day

Year

List any known allergies

Does this participant carry an EpiPen for emergency use *

YesNo

List any medical conditions or medications taken that we should be aware of:

Emergency Contact Name *

Relationship to Participant *

Emergency Contact Phone Number *

Parent/Guardian Consent

This certifies that the participant is able to participate in Youth Pride Conference on March 25, 2023, held at 5200 Crayton Road, Naples, FL 34103 sanctioned by GLSEN, Inc. By signing below parent(s)/legal guardian(s) hereby agree to indemnify and hold harmless and forever release GLSEN, Inc. and its directors, officers, employees and agents against and from any and all claims and damages, suits and proceedings, medical expense or expense of every type, all or part thereof which arise out of or relate to any activities of the participant or GLSEN.
In the event of an emergency, GLSEN representatives are authorized to engage a licensed doctor to render medical services which may, in the sole discretion of the doctor, be necessary; GLSEN representatives are also authorized to take participants to the hospital if necessary and parent(s)/legal guardian(s) agree to pay all doctor, hospital and related bills.

Parent/Guardian Name *

Parent/Guardian Signature *

Date *

Media Release Form

Youth Pride Conference | Saturday, March 25, 2023. 5200 Crayton Road, Naples, FL 34103

Please check the box below that applies: *

Yes - I do consent to the participant being recorded and/or photographed by GLSEN Collier County at the Youth Pride Conference on March 25, 2023 held at 5200 Crayton Road, Naples, FL 34103.No - I do not consent to the participant being recorded and/or photographed by GLSEN Collier County at the Youth Pride Conference on March 25, 2023 held at 5200 Crayton Road, Naples, FL 34103.

Statement of Consent

Participant/Parent/Guardian hereby grants media the irrevocable, unconditional and unrestricted right to photograph, record, videotape and/or interview participant and to use, publish, broadcast, and publicly display participant’s name, voice, likeness, biographical information, and any or all of the footage in any of the media's programming, publications, or the promotion thereof. In addition, participant/parent/guardian agrees that the rights granted hereunder shall include the perpetual, worldwide right of media and its parent, subsidiaries, and affiliated companies to edit, telecast, cablecast, rerun, record, publish, reproduce, use, syndicate, license, print and/or distribute for any purpose, in any manner and in any medium or forum – whether now known or hereafter devised – the footage, or any portion thereof without payment of consideration.

Participant First and Last Name *

Participant Signature *

Date *

Parent/Guardian Name *

Parent/Guardian Signature *

Date *