SAN DIEGO YOUTH LEADERSHIP CONFERENCE

(Joseph H. Pendleton Youth Leadership Conference Inc.)
PO Box 1494, Fallbrook CA 92088­1494

A PATRIOTIC EDUCATION PROGRAM

Of
The Military Order of the World Wars
Date of Application _________________

Applicant Full Name: ___________________________________________ Age _____ Male _____ Female _____
Last First MI
Home Address: ________________________________________________________________________________
Street City State Zip
Telephone No: ( ) _________________Social Security No _____-_____-_____ Soph ___ Junior ___ Senior ___

Email Address: ____________________________________________ T-shirt Size: S M L XL XXL

Name of Parent or Guardian: _____________________________________________________________________

Name and Address of Student's School: _____________________________________________________________

_____________________________________________________________
Session Applied for Session 1 (BSA Orange County Outdoor Education Center) (July 11 – 16)

(If traveling by means other than Auto and you expect someone to meet you at your destination, complete the
Following) I will arrive by ______________________ by _____________________ at ______________AM/PM
airport, train station plane, train
by the following mode of transportation ___________________________________________________________
include flight or train information

(Plan your trip to arrive at the conference not earlier than 1:00 PM nor later than 3:00 PM on Sunday of the first day
of the conference)

I certify that this application is complete and that all information is true to the best of my knowledge (Incomplete
applications will be returned).

Signature of Applicant: ______________________________________ Date: _____________________________

School or Sponsoring Organization Recommendation:

"I believe that this student possesses the qualifications to benefit from this leadership conference. The student
possesses the academic qualifications as well as the motivation to become a leader and influence the actions of
others for the benefit of our nation."

Name of School/Sponsor Official: ______________________________________ Title: ______________________

Home Phone ( ) ____________________ Work Phone ( ) ____________________________ ext. _______

Note: Applications must be returned to the sponsoring organization in ample time to process and submit to the
conference director by 17 June 2010. Funds are committed for housing, food services, and other logistic support and
it is to allow sufficient time for processing applications, and the administrative and logistics details in preparations
for the YLC. Applications will not be accepted or refunds made after the dates specified in the brochures.

1
 AUTHORIZATION AND RELEASE FORM
I (we), the undersigned being the natural parents and/or the designated legal guardian(s) or custodian(s) of
__________________________________, a minor aged ________ years, date of birth: ______________ hereby authorize,
consent and contract as follows:

Permission is expressly granted for said minor child to attend the Youth Leadership Conference (YLC) to be held at BSA
Outdoor Education Center, Irvine CA during the period of 11 to 16 July, 2010 inclusive, including the necessary travel time,
under the joint sponsorship of the Military Order of the World Wars (MOWW) and/or its affiliates, hereinafter referred to as
MOWW.

It is understood that said child was invited to attend the Conference after being selected from among other applicants in a contest
conducted and sponsored by the MOWW, who will supplement the expenses incurred by the child's attendance, including
transportation, tuition, lodging, meals, tours, materials and all Conference activities.

In consideration of the payment of the aforementioned expenses, I (we) hereby release and contract to hold harmless, the
MOWW, and any other cosponsors of the YLC, from any and all liability and/or responsibility for the child's welfare, well-being
and control for the entire period of the Conference, including the day of arrival, and the day of departure from the Conference
site.

This is a voluntary release of liability and complete assumption of risk. I hereby release The Irvine Ranch Outdoor Education
Center and all agencies and instrumentalities thereof, its agents, officers, servants and personnel (hereafter “the releasees”), from
any and all liability, claims, demands and actions whatsoever resulting from my presence on The Irvine Ranch Outdoor
Education Center, or my involvement in social events and actions whatsoever resulting from my presence, or my involvement in
social events, tours, training and living in quarters aboard The Irvine Ranch Outdoor Education Center.

This release applies to myself, and to my parents, spouse, children, guardian, executors, future heirs, assigns, creditors and
administrators. This release of liability includes, but is not limited to claims based on negligence, both passive and active, of the
MOWW arising out of or relating to any loss, damage, illness, death or injury that may be sustained while on The Irvine Ranch
Outdoor Education Center. This release also applies to all dangers inherently involved in the event in which I desire to
participate. I understand that the risks involved in this event include, but are not limited to, risks resulting from walking through
training areas, rough terrain, my personal physical condition, vehicles on and around the training areas and lack of hydration.

I understand that no special measures have been taken to specifically address the needs, tendencies and care of minor children. I
agree that this release applies, not only to myself, but also to my minor children who accompany me, and to any minor children
entrusted to my care or guardianship.

I further state that I, _____________________have carefully read the foregoing release, know the contents thereof, and sign this
release as my own free act, on behalf of myself and/or my child or children for whom I am authorized to act as legal guardian.

Enclosed is a check for $150.00 payable to the J. H. Pendleton YLC Inc. If the applicant does not arrive at the proper time and
place for the conference, it is understood that this sum will be forfeited.

Date: _________________ Signature of Releaser (Student) _______________________________________

____________________________________________ _______________________________________________
Parent signature Parent signature

Relationship: _________________________________ Relationship: ___________________________________