Immersive Leadership Youth Enrichment Program

The Immersive Leadership Program is a youth enrichment and leadership development initiative serving teens ages 6th-12th Grade at OneBodyENT’s headquarters in the Citadel Mall in central Colorado Springs & The Flying Horse Foundation. The program provides a structured, creative, and empowering environment where young people build essential life skills, strengthen their confidence, and expand their vision of what is possible for their futures.

This is a FREE 8 week incentive-based program that will start on October 1st - November 21st.

Thur & Fri. from 4:00pm - 7:00pm at the OneBodyEnt HQ at the Citadel mall.

Saturday Days at from 10/10-11/7: 1:00pm-3:00pm @ Flying Horse Foundation - 9663 E Palmer Divide Ave, Larkspur, CO 80118

Meals will be provided.

I am the parent/guardian of the minor child listed on this application, on behalf of ourselves, our heirs, executors and administrators, hereby release, waive, acquit and forever discharge The Men of Influence/Women of Impact, their representatives, successors, insurers, assigns or any other person or entity associated with any of the above organizations such as staff, directors or volunteers, from all liability, claims, demands, or causes of action for any and all loss, damage, injury or death and any claim of damages resulting from use of facilities owned or controlled by the above organizations, or participation in activities of said organizations either at or away from the Immersive Leadership Program.

I give my permission to the Men of Influence/Women of Impact; Staff to collect information via online or written surveys, questionnaires, interviews, and focus groups from the minor child listed on this application. All information received will be kept strictly confidential. Data gathered through these means will be summarized in the aggregate and will exclude all references to any individual responses. The aggregated results of these analyses may be shared with participating organizations, funders, and other community stakeholders to evidence program effectiveness and/or Club impact on our members.

School Information

I give my permission to the Men of Influence/Women of Impact; Staff, Partners and Partnering School Districts to exchange information regarding the minor child listed on this application. The purpose of the exchange is to help all organizations do a better job of helping the students be successful in school and in life.

Data Sharing:

I understand that the Men of Influence/Women of Impact; Staff may share information about the minor child listed on this application with participating organizations for research purposes and/or to evaluate the program’s effectiveness. Information that will be disclosed to Men of Influence/Women of Impact may include the information provided on this membership application form, information provided by the minor child’s school or school district, and other information collected by Men of Influence/Women of Impact; Staff, including data collected via surveys or questionnaires. All information provided to Men of Influence/Women of Impact will be kept confidential.

Technology:

As a member of the Immersive Leadership Enrichment Program, your child will have access to the Internet. While precautions are being taken, it is possible that he/she may access inappropriate sites. The Men of Influence/Women of Impact; Staff will have rules and consequences at the Teen Night for such behavior; however, we will not be responsible for the consequences of such access.

Miscellaneous

I understand that the Men of Influence/Women of Impact; Staff is not responsible for lost or stolen items. Parents and Teen Night members are responsible for their own transportation to and from the Immersive Leadership Enrichment Program. As a drop-in facility, we are not responsible for Immersive Leadership Enrichment Program members’ whereabouts.

I give permission for my child’s picture, moving pictures, or any other graphic depiction or likeness, to be used by the Men of Influence/Women of Impact and its activities. I also understand who the Immersive Leadership Enrichment Program is not, nor does it claim to be, a licensed day care center.

I have read the completed application and this form, understand the rules of the Immersive Leadership Enrichment Program and request who my child be admitted into membership.

I give my permission to the Men of Influence/Women of Impact to share information about the minor child listed on this application with Participating organizations for research purposes and/or to evaluate the program’s effectiveness. Information that will be disclosed to participating organizations may include the information provided on this membership application form, information provided by the minor child’s school or school district, and other information collected by The Men of Influence/Women of Impact, including data collected via surveys or questionnaires. All information provided to participating organizations will be kept confidential.