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Ronald Reagan Student Leadership Program

Thank you for your interest in the 2024 Ronald Reagan Virtual High School Student Leadership Program. To streamline the registration process, you will need the following:

•   Student email address (please use a personal Google email, not a school email address. This is needed for our Google Classroom.)
•   Parent/Guardian contact information (email address, mailing address, phone number, etc.)
•   School information

You may save and resume your registration at any time.

Student First Name

Student Last Name

Gender

Birthdate

Grade in Fall 2024

High School Graduation Date

Session Selection

How did you hear about us?

Name of School

Name of Student

How did you hear about us - other:

Student Email **We utilize Google classroom to deliver a portion of the curriculum. Students must have a gmail account for this purpose >>

Student Home Phone

Student Mobile Phone

Street Address

City

State

Zip Postal Code

School Name

School Street Address

School City

School State

School Zip Postal Code

Do you have a computer with a working camera?

Do you have an internet connection that can facilitate video chat or a platform like Zoom?

Our virtual Student Leadership Program is a “camera on” event. We ask all students to leave their camera on to maximize engagement and their learning experience throughout the program. If there are special circumstances preventing your student from participating on camera, please email studentleadership@reaganfoundation.org

T-Shirt Size for Program T-Shirt

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Street Address

Parent/Guardian City

Parent/Guardian State

Parent/Guardian Zip Postal Code

Parent/Guardian Home Phone

Parent/Guardian Cell Phone

Parent/Guardian Email

Additional Parent/Guardian First Name

Additional Parent/Guardian Last Name

Additional Parent/Guardian Street Address

Additional Parent/Guardian City

Additional Parent/Guardian State

Additional Parent/Guardian Zip Postal Code

Additional Parent/Guardian Home Phone

Additional Parent/Guardian Cell Phone

Additional Parent/Guardian Email

Parent/Guardian Release

1. Permission to Participate: I hereby give permission for my child to participate in the Ronald Reagan Virtual Student Leadership Program. I understand that the student is responsible for completing the work assigned during the program and must attend each day in order to receive their certificate of completion.

2. Conduct: I fully understand all participants are to abide by and accept the rules and requirements regarding conduct during the program. Rules and expected conduct will be discussed with the participants on day 1 of the program. Any participant determined to be in violation will be removed from the program at their parent/guardian’s expense.

3. Waiver of Claims for Liability: Participants in the Ronald Reagan Student Leadership Program, both online and in-person, along with their guardians, hereby release the Ronald Reagan Presidential Foundation and Institute, its staff, trustees, vendors, and other agents (including the National Archives and Records Administration and their Library staff) from all liability. This includes all potential claims, demands, and causes of action resulting from program participation, encompassing personal injuries and property damage.

4. Parent/Guardian Consent:

Name:

Cell Phone:

Email:

By clicking the boxes below, you agree to the following:

I confirm that I am an authorized parent/guardian of the student named at the top of this form.

I agree to the Ronald Reagan Presidential Foundation and Institute privacy policy and agree to receive communications from the organization, its successors, or assigns.

I consent to having the Ronald Reagan Presidential Foundation and Institute store submitted information so they can facilitate student's enrollment.

I understand that the virtual Student Leadership Program is a “camera on” event and students are expected to leave their camera on to maximize engagement and their learning experience throughout the program. If there are special circumstances preventing your student from participating on camera, please email studentleadership@reaganfoundation.org.

I confirm that I have carefully read this authorization and fully understand its contents and voluntarily consent to its terms and conditions.

Liability/Media Release Form

This letter confirms that I hereby grant the Ronald Reagan Presidential Foundation & Institute (RRPFI) the right to obtain and/or use my/my student’s photograph, digitized image, video image, name and/or voice for educational and informational purposes in conjunction with the RRPFI Education Programs and Events. I understand that all images, productions and content, therein, become the exclusive property of the Ronald Reagan Presidential Foundation & Institute.

I understand that there will be no compensation for the use of any photograph, digitized image, name, video image and/or voice.

YES, I give my permission to include my/my student’s individual picture and name in all videos, photographs, and media related to the Ronald Reagan Presidential Foundation and Institute's Education Events.NO, I do not give my permission to include my (my student’s) individual picture with name identified. I understand that I (my student) MAY still be included in group shots, but I (my student) will not be identified.

All students under the age of 18 must have this release signed by their parent/guardian. Thank you for your cooperation.

Terms of Acceptance & Signature

I, the student, parent or guardian for this liability release form, warrant the truthfulness of the information provided in this application.

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

Date Signed

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