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Hilton Americas – Houston

19th NAIS Student Diversity Leadership Conference ( a nd joint sessions with p o cc)

George R. Brown Convention Center

Conference preview

25th NAIS People of Color Conference


NAIS Welcome

Welcome to the 2012 People of Color Conference (PoCC) and the Student Diversity Leadership Conference in Houston. This is the second time in NAIS history that a vibrant and culturally diverse city in the Lone Star State has served as host to the conferences. The Greater Houston Partnership (www.houston.org) reports that Houston has been recognized in the following categories: Most Racially/Ethnically Diverse Large Metro Area (Kinder Institute for Urban Research & The Hobby Center for the Study of Texas, 2012); Top City For Women-Owned Business Revenue (The State of Women-Owned Business Report, 2012); Top Texas Tourist Destination (Office Of The Governor, Economic Development and Tourism, 2009); The World’s Most Inventive Cities (BusinessWeek, 2009); and Cities of Greatness in 2012 (The Street, 2012). These honors — and the innovation and diversity they represent — provide a few of the reasons why Houston is a logical match for PoCC/SDLC 2012. In both large and small ways, we will be celebrating the 25th PoCC in Houston. Notice that the unique PoCC/SDLC logo celebrates this important milestone, which occurs during the same year that NAIS celebrates 50 years of existence. As we celebrate this milestone, we also wish to reaffirm the answer to the question of who should attend PoCC. In 2001, the NAIS board affirmed that PoCC is “a conference by and for people of color and inclusive of all.” What does that mean as you decide who from your school

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Photography used in preview courtesy of the Greater Houston Convention and Visitors Bureau.

will attend? This decision is up to you, and all participants will be welcome, but its primary purpose is for people of color (and experienced allies and practitioners of all backgrounds, races, and ethnicities). We encourage you to see PoCC as different from a diversity conference for newcomers to diversity work. The purpose of PoCC is to help participants understand their roles in advancing equity and justice around racial and ethnic identity. The affinity group work offers a safe environment where these conversations can happen effectively. In November 2006, the NAIS board reaffirmed the mission and purpose of PoCC by stating: “PoCC should be designed for people of color as it relates to their roles in independent schools. Its programming should include offerings that support people of color as they pursue strategies for success and leadership. Its focus should be on providing a sanctuary and networking opportunity for people of color and allies in independent schools as we build and sustain inclusive school communities.” We are grateful to the Houston co-chairs, local committee, and heads of school, and to the leaders and staff of the Independent Schools Association of the Southwest (ISAS) for their enthusiastic support in helping us plan and deliver this year’s PoCC. We are also grateful to the new leadership of SDLC and its faculty members for working to provide a transformative conference for the next generation of advocates for equity and social justice.

Patrick F. Bassett

Harold Eugene Batiste III

NAIS President

NAIS Vice President, School Field Services and Equity & Justice Initiatives


Houston has also been the location of key moments in our country’s history. In the postCivil War era, Houston served as a cultural and economic center of opportunity for recent freedmen in the Gulf Coast region. During World War I, African-American servicemen in Houston protested and fought police brutality at Camp Logan (present-day Memorial Park). In the 1940s Houstonian Herman Sweatt argued before the Supreme Court for his right to equal access to the University of Texas Law School, opening the door for the landmark 1954 Brown v. Board decision ending Jim Crow laws related to school

This year’s theme taps both into that energetic history and culture and into the prominence of the oil, gas, and energy industries of Houston, which is often called the “Energy Capital of the World.” We as hosts ask you to join us in celebrating NAIS’s 25 years of fueling the power of change in independent schools. This conference would not be possible without the heads of schools who have graciously supported our efforts in organizing the conference and the school visits and the members of the Local Committee for their hard work, ideas, and enthusiasm in piecing together the program.

Houston Local Committee

You may already think of Houston a focal point for NASA’s Space Program; a hub of medical innovation and the home of the M.D. Anderson Cancer Center; and a place of business for energy companies around the world. But did you know that Houston also boasts a dynamic, cosmopolitan atmosphere? Houstonians come from all corners of the globe and from all walks of life. Sizable Asian, Middle Eastern, Latino, and African-American communities help to shape the identity and culture of our diverse and international city today.

segregation. In the 1960s President Lyndon Johnson, from Texas, ushered in arguably three of the most important pieces of legislation in American history — the Civil Rights Act of 1964; the Voting Rights Act of 1965; and the Immigration and Nationality Act of 1965, which ended decades of dreadfully racist policies designed to keep people of color and other “undesirable” groups from approaching our shores. Lastly, Houston has served as a refugee center since the fall of Saigon, leading to the second largest Vietnamese American community in the nation.

Co-Chair Welcome

It is with great pride and pleasure that we welcome NAIS’s People of Color Conference and its participants to Houston.

Enjoy our great city and the conference!

Jack Soliman

Chelsea Collins

John Hoye

William P. Hobby Chair in Social Science, St. John’s School (Texas) Local Committee Co-Chair

Middle School Dean, Kinkaid School (Texas) Local Committee Co-Chair

Director of Athletics, Awty International School (Texas) Local Committee Co-Chair

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Lighting the Way to the Millennium: Our Selves, Our Children, Our Schools

1996

The First National Conference for Teachers and Administrators of Color in Independent Schools Vision 2020

1993

1989

We’re celebrating 25 years of PoCC! Each year, each host city and conference theme has given the conference a unique character and cultural perspective.

1992

1986

1995

Conference History

1997

A Vision for Building New Alliances

Seeing Beyond — Becoming Advocates for Creating Multicultural Educational Institutions

1991

Unity in the Midst of Diversity

From Thought to Action

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Journey to Spirit: Solidarity and Voice through Dialogue

1998

1994

1990

Common Ground

Los Colores de la Educación — Continuing to Build Environments in Independent Schools that Address the Needs and Issues of Children and Adults of Color

Puerto Rico — The Caribbean: Encounter History, Culture, and Self


Bridging Cultures, Sharing Stories

2007

2009 2010

2006 2004 At the Crossroads: Deepening Perspectives the Cultural Kaleidoscope (PoCC); Collide-oscope: Twisting Lenses, Seeing Change (SDLC)

Learning from the Past, Leading for the Future: Reshaping Traditions (PoCC); The Time is Now: Emerging from Our Past as We Shape Our Future (SDLC)

Moving Mountains: Mining Within (PoCC); Mine, Yours & Ours: The Responsibility to Navigate the Rapids of Change (SDLC)

Catching the Tides of Change, Riding the Waves of Opportunity: Twenty-Three Years of Empowering People of Color in Independent Schools (PoCC); Coast 2 Coast, Seek to See: Anchoring Ourselves in the Community Harbor (SDLC)

2011

2002

Connecting Cultures, Connecting Worlds

Miami: Gateway to Multiculturalism (PoCC); Connecting to Self, Connecting to Others: Eleven Years of Diversity and Advocacy Training for Independent School Students (SDLC)

2005

2001

The Children Are Our Business

E Huaka’i Pū Kākou (Let’s Voyage Together), Exploring a Majority of Minorities (PoCC); X Marks the Spot: Journey to a New Revolution (SDLC)

2008

2003

1999 2000

Mosaic: Connecting Communities for Action

Nourishing Ourselves for the Swim Upstream, The Emerald City: Seattle (PoCC); Upstream, Uphill, Up to Us: Preparing Ourselves for the Challenges Ahead (SDLC)

Music for Life. Food for Thought. Friendships That Sustain. Rebuilding and Preserving the Essence of People of Color in Independent Schools (PoCC); Preserving Self, Building Community, and Sustaining Change: The Essence of Student Leadership (SDLC)

We the People: Painting Our New Mural of Community (PoCC); Updating Our Status: A Declaration of Interdependence (SDLC)

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PoCC/SDLC Registration

Overview

The Destination

George R. Brown Convention Center, Level 3 Tuesday, December 4 2:00 – 6:00 PM Wednesday, December 5 7:00 AM – 8:00 PM Thursday, December 6 7:00 – 7:30 AM,   9:15 AM – 6:00 PM Friday, December 7 7:00 AM – 6:00 PM Saturday, December 8 7:00 – 11:00 AM

Home to a respected and energetic cultural arts scene, celebrated restaurants featuring flavors from 35 countries, world-renowned theater groups, and the brains behind U.S. space exploration, Houston is a diverse metropolis brimming with personality. With a revitalized downtown, Houston offers a cosmopolitan setting for PoCC/ SDLC. The convenient METRORail connects Downtown with the Museum District, the Texas Medical Center, and Reliant Park, making it easy to see sites such as Space Center Houston, the Downtown Aquarium, and the Museum of Fine Arts. ForbesTraveler.com ranked Houston as one of the best restaurant cities in America, and with 56,405 acres of total park space, Houston ranks first among the nation’s 10 most populous cities in total acreage of park land. PoCC and SDLC will take place in two facilities this year: Hilton Americas – Houston 1600 Lamar Street, Houston George R. Brown Convention Center 1001 Avenida de las Americas, Houston All PoCC general sessions will take place at the George R. Brown Convention Center, but all other PoCC activities, workshops, and events will take place at Hilton Americas – Houston. All SDLC activities will take place at George R. Brown Convention Center.

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Workshops PoCC attendees can choose from more than 65 workshops that are 75 minutes in length and offered in four blocks during the conference. Practitioners and experts will present workshops in the following topical areas:

How to Get the Most Out of PoCC

llPeople of Color in Leadership: Pathways

and Programs to Success llNurturing Our Soul: Self-Care Strategies for Success For 24 years, PoCC has nurtured and susllExpanding Our Tool Box: Curricular tained people of color in independent schools. and Professional Skills for Excellence The creation of this sanctuary is possible llBuilding Inclusive Communities for People of because of the participants’ acceptance Color: Programs and Initiatives to Strengthen of cherished community norms. Speakers, People of Color in Independent Schools affinity group work, and workshop presenters Exploring Racial/Ethnic Identities for People ll will not only inform participants, but also of Color: Our Many Journeys and Stages challenge them to think in different and new ways. Conference attendees will have the Featured Speakers opportunity to network and build connections with others who are committed to building One featured speaker will present during each and sustaining independent school communiof the first three workshop blocks, giving conferties for people of color. ence attendees expanded choices in professional In order to maximize the conference experience, participants are expected to lean into discomfort and accept conflict as a catalyst for change. When this is done effectively, participants are fully present, they suspend judgment of themselves and others, and they listen and think before speaking from their perspectives. Participants’ commitment to honor confidentiality fosters this respectful community. Attendees of PoCC will leave energized and recommitted. Revised by members of NAIS’s Call-to-Action, July 2008

development and an opportunity to hear from noted people of color from diverse fields and backgrounds.

Dialogue Sessions In addition to the third affinity group session that brings together adults from PoCC and students from SDLC, the Saturday Adult/Student Dialogues are an opportunity for adults to learn from students. The dialogue groups meet by home state or regions. Using skills cultivated during SDLC, students will facilitate a dialogue on applying strategies from both conferences. This session empowers the students with an important voice as advocates for diversity, multiculturalism, and equity and justice. Attendance by adults is vital to the success of this session. It is also critically important for the adults to be led by the students and for the adults to practice good followership. 7


Overview Affinity Group Work at PoCC Affinity group sessions are uniquely designed to help conference participants develop their own racial/ethnic identity based on the PoCC conference theme. The qualitative difference between PoCC affinity group work and other aspects of the conference — in which all conference participants experience the conference as a whole group — is that the affinity group sessions provide an opportunity for each participant to explore her or his own specific racial or ethnic identity development in a safe and trusted environment. Led by a team of trained facilitators, the curriculum for this year’s affinity group work includes three sessions that provide opportunities to celebrate, share successes and challenges, and engage in adult/student discussions based on racial/ethnic and gender identity. The overarching vision for PoCC affinity group work includes the following components:

llfacilitating opportunities for affirming, nurturing, and celebrating; and

lldiscussing issues related to racial/ethnic iden-

tity development in a safe environment where people who share a racial/ethnic identity can come together to build community, fellowship, network, and empowerment.

Anita L. Sanchez will serve as the lead facilitator of our affinity group work. She is an organization development consultant, trainer, and speaker focusing on diversity and inclusion, large system change, team building, and coaching. Learn more at www.sancheztennisassociates.com

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Thursday, December 6 25 Year Celebration: Fueling the power of change Through the shared experiences of each affinity group, participants collaboratively build the history of PoCC and tap into their changing sources of energy and strength. Friday, December 7 Power and Action: Refining our shared Community Participants discuss their commitment to sustain their sources of power through self-generated topics and storytelling. Saturday, December 8 Energizing our Future Adult and student participants unite to be empowered to take action and fuel change in our communities. Which Affinity Group Do I Attend? Affinity group conversations are for the singular lens of our individual racial/ethnic background. We may have cultural lenses that are more diverse that create the tapestry within our racial group, adding even more beauty to our communities. However, during affinity groups we speak from the “I” perspective. Therefore, they are not interest groups, but rather racial/ethnic identity groups. Please do not attend an affinity group out of interest or desire to learn something about racial/ethnic identities and/or experiences that are not your own. Developed by members of NAIS’s Call-to-Action, July 2012


Highlights PoCC Networking Coffee Breaks and Book Signings Hilton Americas – Houston, Level 2 & 4 Following the Opening Ceremonies, General Sessions, and noted Featured Speakers Sessions, grab a cup of coffee and a chat before heading off to the next conference activity. Many of our speakers will be signing books during these break times.

Expanded Affinity Group listing

Note an expanded and more inclusive listing of racial and ethnic groups for self-identification on the PoCC and SDLC registration forms, including:

llBlack, African Heritage,

Afro-Caribbean Heritage, African American;

NAIS Bookstore Hours

NAIS Bookstore and Cyber Café

Wednesday 1:00 – 6:00 PM

Hilton Americas – Houston, Level 4 NAIS will offer a complimentary Cyber Café as well as the NAIS Bookstore, which provides a wide range of books and materials on people of color, building and sustaining inclusive school communities, and the works of keynote and featured speakers at the NAIS Bookstore.

llLatino/a Heritage,

Thursday 7:00 AM – 7:30 PM

llEast Asian Heritage,

Friday 7:00 AM – 6:45 PM

Hispanic Heritage, Latino/a or Hispanic American; Southeast Asian Heritage, South Asian Heritage, Pacific Islander Heritage, East/Southeast/South Asian, Asian American, Heritage from the Indian Sub-Continent;

Saturday 7:00 AM – 1:00 PM NAIS Cyber Café Hours

llFirst Nations Heritage,

Wednesday 7:30 AM – 5:00 PM

llWhite, European Heritage,

Thursday 7:30 AM – 5:00 PM

llGreater Middle Eastern

Friday 7:30 AM – 5:00 PM

Indigenous and Aboriginal People, Native American; European American;

Heritage, Arab Heritage, West Asian Heritage, Middle Eastern or Arab or West Asian American;

Saturday 7:30 – 11:00 AM

State and Regional Meetings Friday, December 7 1:30 – 2:30 PM Hilton Americas – Houston This time is set aside for state and regional diversity committees to meet with their constituents. For those states and regions without diversity committees, this time should be used for meeting other attendees from your area and for networking on ways to use experiences gained at the conferences as a catalyst for change back at home.

llMultiracial Heritage,

Multiracial American;

llTransracially Adopted; and llInternational — Citizens

from Countries Outside of the U.S., Recent Arrivals to the United States.

Gay, Lesbian, Bisexual, and Transgendered (GLBT) Social Hour Friday, December 7 7:00 – 8:00 PM Location TBA 9


Keynote and Featured Speakers 10

Helene Cooper

Dan Choi

PoCC/SDLC Opening Ceremonies Speaker

PoCC Featured Speaker

Thursday, December 6 8:00 – 9:15 AM George R. Brown Convention Center

Thursday, December 6 10:00 – 11:15 AM Hilton Americas – Houston

Helene Cooper has a unique window into world events. As White House correspondent for The New York Times, she has a front row seat to the major breaking stories from Washington. Coupled with her experience as a diplomatic correspondent for The New York Times and a reporter and foreign correspondent at The Wall Street Journal, she has a perspective few others can offer. She has covered international economics, politics, race, and foreign policy. Her own story is just as compelling. Born into privilege in Liberia, she fled the Liberian coup in 1980 with her mother and sister. In her bestselling memoir, The House at Sugar Beach, she chronicles her journey from living a life of affluence and security to escaping for her very life. It all led to her search, 23 years later, for the sister — and country — she had left behind.

In March 2009 Lt. Dan Choi, a West Point graduate and Iraq veteran, announced that he was gay on The Rachel Maddow Show. Despite Choi’s unique credentials as a fluent Arabic speaker, one month later the Army began discharge proceedings against him. Choi had served for a decade under “Don’t Ask, Don’t Tell,” a policy that forced soldiers to hide their sexual orientation. Choi felt he was following the Cadet Honor Code when he made the decision to no longer lie about his identity. At Choi’s trial, he demonstrated his fluency in Arabic and presented more than 260,000 support statements. The military board decided to discharge Choi for violation of “Don’t Ask Don’t Tell.” While the case was appealed, Choi served openly in his infantry unit for more than a year. During that time, he publicly pushed for the repeal of the policy and took part in many demonstrations. He was arrested several times for handcuffing himself to the White House fence. In 2010 Choi attended the bill signing that would repeal “Don’t Ask Don’t Tell.” Today, Choi continues to advocate for full Lesbian, Gay, Bisexual, and Transgender (LGBT) civil rights and veterans’ health. He appears frequently on major news programs and serves on the boards of Marriage Equality USA and the American Foundation for Equal Rights.

Book Signing Event


Keshni Kashyap

William Perez

PoCC Featured Speaker

PoCC General Session Speaker

Thursday, December 6 3:45 – 5:00 PM Hilton Americas – Houston

Thursday, December 6 5:30 – 6:30 PM George R. Brown Convention Center

Born in Singapore and raised in California, Keshni Kashyap is most recently the writer and creator of the award-winning graphic novel Tina’s Mouth: An Existential Comic Diary, which was published in January 2012 by Houghton Mifflin Harcourt and chronicles the life and times of a 15-year-old Indian-American teenager growing up in contemporary Los Angeles. The book has received much praise. The Wall Street Journal, in its profile of the book writes, “Ms. Kashyap transfers her adolescent angst — and fascination with philosopher Jean-Paul Sartre — to her protagonist, Tina Malhotra, the youngest daughter of Punjabi immigrants in Southern California, simultaneously tolerating over-bearing, sari-swathed aunties and snooty high-school cliques.” Trained as a filmmaker, Kashyap’s short films have screened in more than 40 festivals around the world. She is also an occasional contributor to The Daily Beast. Currently, she divides her time between New York and Los Angeles. She is a graduate of Chadwick School (California).

William Perez is Associate Professor of Education at Claremont Graduate University (CGU). His research focuses on immigrant students, academic achievement, and Latino higher education access. Before joining CGU, he worked at various research institutes including the RAND Corporation, the Stanford Institute for Higher Education Research, the UCLA Neuropsychiatric Institute, and the Tomas Rivera Policy Institute. His research on undocumented students has been published in various academic journals including The Hispanic Journal of Behavioral Sciences, The Journal of College Admissions, The Journal of Hispanic Higher Education, and New Directions for Student Services. Perez is also the author of the acclaimed book We ARE Americans: Undocumented Students Pursuing the American Dream, which was awarded the 2009 Mildred Garcia Prize for Excellence in Research by the Association for the Study of Higher Education. Born in El Salvador, Perez came to the United States at the age of 10 to escape the country’s civil war and spent his remaining childhood in Pomona, California. He earned his BA at Pomona College, and his Ph.D. at Stanford University. Most recently, Alma Magazine named him as one of four Lo Mejor de Nosotros (One of Our Best) in its 50th Anniversary Hispanic Heritage Month edition.

Book Signing Event

Book Signing Event

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Keynote and Featured Speakers

Kim Phuc Phan Thi

Steven Jones

PoCC General Session Speaker

PoCC Featured Speaker

Friday, December 7 8:00 – 9:00 AM George R. Brown Convention Center

Friday, December 7 3:00 – 4:15 PM Hilton Americas – Houston

In 1972, Americans and the South Vietnamese Airforce dropped napalm bombs on a village near Saigon. Nine-year-old Kim Phuc Phan Thi was photographed running down the road, screaming from burns to her skin. That unforgettable Pulitzer Prize-winning photograph changed the way the world looked at the Vietnam War, and at all wars. After two years of medical care, Phan Thi returned to her village. Her government subjected her to endless interviews, used her story in propaganda films, and supervised her as a “national symbol of war.” In 1986 she settled in Canada. In a commemorative ceremony for the Vietnam War in Washington DC, as she was delivering a speech, she publicly pardoned the person who had launched the napalm bombing of her village in Vietnam. Phan Thi’s story was turned into the book The Girl in the Picture and the documentary film Kim’s Story: The Road from Vietnam. Kim Phuc Phan Thi was designated UNESCO Goodwill Ambassador in 1994. Ever since, she has dedicated her life to promoting peace. She founded the Kim Foundation International, which provides medical and psychological support to children who are victims of war, to help them overcome their traumatic experiences.

Steven Jones is the C.E.O. of Jones & Associates Consulting, Inc., a firm that specializes in diversity and organizational change consulting. Named a national Top Diversity Expert by DiversityInc Magazine, he is a recognized national speaker, trainer, and consultant. Jones holds a B.S. in Computer Science, a M.Ed. in Counseling, and a M.S. and Ph.D. in Industrial/ Organizational Psychology. His passion for fighting oppression has shaped his professional and personal life. Jones works with non-profit organizations, corporations, government agencies, and educational institutions nationwide. He has served as a facilitator and consultant to NAIS, as well as to independent schools nationwide. Other clients with which he partners include CBS, Honda, Lexus, LG, Nokia, Qualcomm, Sempra Energy, Southern Company, and Toyota. A published author of Journey to Excellence, Jones has also taught graduate-level courses at Alliant International University, National University, San Diego State University, University of California at San Diego, and the University of San Diego. Some of those courses he teaches include “The Psychology Applied to Teaching Diverse Students,” “The Diverse Classroom,” and “Diversity in the Workplace.”

Book Signing Event

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Bernard Harris

Baratunde Thurston

PoCC Featured Speaker and SDLC Keynote Speaker

PoCC/SDLC Closing Ceremonies Speaker

Friday, December 7 (for PoCC) 4:30 – 5:45 PM Hilton Americas – Houston In 1995, Bernard Harris became the first AfricanAmerican to walk in space. A veteran astronaut for more than 19 years, he has logged more than 438 hours and traveled over 7.2 million miles in space. After receiving his MBA degree from the University of Houston and then a Doctorate of Medicine (MD) from Texas Tech University, he trained as a flight surgeon at the Aerospace School of Medicine, Brooks Air Force Base in San Antonio, Texas. He served as vice president and chief scientist of SPACEHAB, Inc., an innovative space commercialization company, where he directed the company’s space science business. He also served as vice president of business development for Space Media, Inc., an Informatics company, establishing an e-commerce initiative that is now part of the United Nations’ education program. He is currently chief executive officer and managing partner of Vesalius Ventures, Inc., a venture capital firm that invests in early to mid-stage healthcare technologies and companies. Harris believes that education and effort will allow anyone to meet any challenge in life, inspiring others to reach for the stars. Among the many boards he serves on is the National Math and Science Initiative. Harris is the founder of the Harris Foundation, a non-profit organization that supports math and science education and crime prevention programs for America’s youth.

Saturday, December 8 11:30 AM – 1:00 PM George R. Brown Convention Center Baratunde Thurston, a graduate of Sidwell Fri­ends School (Washington, DC), is a technologyloving comedian. With ancestry that includes a great-grandfather who taught himself to read, a grandmother who was the first black employee at the U.S. Supreme Court building, and a mother who took over radio stations in the name of the black liberation struggle, Thurston has long been taught to question authority. His creative and inquisitive mind, forged by his mother’s lessons and polished by a philosophy degree from Harvard, have found expression in the pages of Vanity Fair and The UK Independent; on the radio waves of WNYC, where he is a regular contributor; and on the screens of news networks such as CNN, MSNBC, BBC, and Al Jazeera. In 2006 he co-founded Jack & Jill Politics, a black political blog that covered the 2008 Democratic National Convention. For the past four years, he has served as director of digital for The Onion. His book, How to Be Black, was published in February 2012. He writes the monthly back page column for FastCompany. Thurston travels the world speaking and advising on the subjects of our digital future, media and democracy, and race and politics. He also performs standup comedy regularly in New York City. Book Signing Event

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Pre-conference Activities

Community Service Opportunities $50 (includes transportation from the George R. Brown Convention Center on Avenida de las Americas) Ticket Required On-site registration is not available.

You must register (on your PoCC or SDLC registration form) by the November 12 deadline.

Houston Food Bank 12:30 – 5:30 PM The Houston Food Bank is the nation’s largest Feeding America food bank, and has been named one of 10 Top-Notch Charities across the nation by Charity Navigator. A network of nearly 500 food pantries, soup kitchens, senior centers, and other agencies feed a total of 137,000 people each week, and provides more than 50 million nutritious meals annually. Volunteers will help build family boxes, senior boxes, backpack buddy bags, and holiday boxes; sort and inspect recovered product from retail stores to be distributed to the agencies; and/or bag rice and beans. Please dress in comfortable attire such as tennis shoes, jeans, and Tshirts. Students who are younger than 16 will need to participate with a chaperone. Star of Hope Mission 1:00 – 5:30 PM The Star of Hope is a Christ-centered community dedicated to meeting the needs of homeless men and women and their children. Positive life changes are encouraged through structured programs, which focus on spiritual growth, education, employment, life management, and recovery from substance abuse. Volunteers will help sort, box, label, and palletized donations for distribution. Closed-toe shoes are required and comfortable attire is suggested. Please be sure to review the full set of guidelines for the project on the PoCC website at www.nais.org.

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Houston Food Bank Waiver/  registration information

In addition to signing up on the PoCC or SDLC registration form, you must also complete a waiver form (one version for adults, one for students), which is included at the end of this conference preview and on the PoCC website at www.nais.org.

STAR OF HOPE Mission WAIVER/  registration information

In addition to signing up on the PoCC or SDLC registration form, you must also fill out a participation form on the Star of Hope Mission website at www.sohmission. org/NetCommunity/ login.


School Visits 8:00 AM – 12:00 PM

$50 (includes transportation from Level 1 of the George R. Brown Convention Center on Avenida de las Americas) Ticket Required On-site registration is not available. You must register for the School Visits (on your PoCC or SDLC registration form) by the November 12 deadline.

School Visits offer independent and special focus schools in the host city an opportunity to offer a site-visit agenda that celebrates each school’s unique culture and mission while sharing the ways in which diversity and multi­ cultural education play a role. THE AWTY INTERNATIONAL SCHOOL www.awty.org The Awty International School, founded in 1956, is a PK3 – 12th grade college preparatory day school serving more than 1,400 students from over 50 countries. Awty is currently the largest private school in the city of Houston and the second largest international school in the United States. The school provides a challenging education, leading to either the International Baccalaureate or the French Baccalauréat. Within a friendly and nurturing environment that encourages learning and the pursuit of excellence, Awty celebrates linguistic, cultural, and international diversity and seeks to maximize the potential in all students as they grow to become responsible world citizens. All students take a second language — English, French, or Spanish. Native-language programs are available in English, French, German, Spanish, Italian, Arabic, Mandarin Chinese, and Dutch.

KIPP HOUSTON www.kipphouston.org The flagship KIPP Way campus is the home of the original KIPP elementary, middle, and high schools and located in southwest Houston. The Knowledge Is Power Program (KIPP) was founded in 1995 in Houston to develop in underserved students the academic skills, intellectual habits, and qualities of character necessary to succeed at all levels of pre-kindergarten through 12th grade, college, and the competitive world beyond. Although the KIPP Way campus serves more than 1,700 students, an additional 2,500 students are on a waitlist to attend one of the three schools on this campus. KIPP now serves nearly 9,000 students in 21 schools in Houston and more than 35,000 students at 129 schools nationally. ST. JOHN’S SCHOOL www.sjs.org St. John’s School is an independent, coeducational day school presenting a 13-year sequence of college preparatory training. St. John’s was founded in 1946 to provide the community with a school of exacting standards in the development of individual, spiritual, ethical, intellectual, social, and physical growth. The school is dedicated to the enhancement and the expansion of future leadership for Houston and the country. Making available the quality of a St. John’s education to people of all different backgrounds continues to be a priority endeavor of the Board of Trustees. In the words of former Chairman of the Board, Jim Elkins III, the school seeks to “build an inclusive community ethnically, culturally, and socio-economically.” St. John’s students and graduates are making history, and we are proud to remember the firm foundation that has allowed for their immeasurable successes and will be forever grateful to the founders for creating these storied cloisters. 15


Pre-conference Activities

Leadership Seminar for People of Color and Women Optional Leadership Assessment and Coaching Session

$250 (includes lunch and materials) 9:00 AM – 5:00 PM Hilton Americas – Houston

Ticket Required On-site registration is not available.

You must register (on your PoCC registration form) by the November 12 deadline.

This new PoCC Leadership Seminar is tailored for people of color and women who aspire to leadership in independent schools. It is based on state-of-the-art leadership development strategies and skills building while creating an experience of encouragement, healing, hope, and transformation. Participants will leave the seminar inspired to declare, “I can do this!” Led by nationally recognized diversity, inclusion, and leadership development expert Steven Jones and leaders in independent schools, the seminar will cover the following topics:

llLeadership Assessment llTrust Building llBrand Management — How do I brand

myself? How do I promote myself without “promoting” myself? llEffective Networking llFinding a Mentor llBuilding and Leading High Performing teams llChange Management llCreating an Action Plan for My Leadership Goals

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Registration for this optional opportunity is done directly through Jones & Association Consulting.

Maximize your development as a leader by completing a 360° Leadership Assessment prior to the conference. The simple online assessment allows you, your school leaders, and your peers to rate your performance on 22 leadership skills such as the courage to lead, planning, communication, valuing differences, and ability to mobilize others. During the conference, in an individual leadership coaching session with Steven Jones, you will review the results of your assessment and build a personal leadership development plan. After the session you will have access to an online tool that supports you in setting your personal goals and tracking progress. To register for this optional leadership assessment and coaching session, contact Glenn Sanders at gsanders@jandaconsult.com or at (619) 298-4100, extension 7004. Cost $450 paid directly to Jones & Associates Consulting, Inc.

Steven Jones is an author and national expert on diversity, inclusion and leadership development. He is C.E.O. of Jones & Associates Consulting, Inc., a firm that specializes in diversity and organizational effectiveness consulting. Jones is also serving as a featured speaker at the 2012 PoCC. See his full bio on page 12.


Leadership Team

Participants will be guided by a talented team of independent school educators, college students who are SDLC alums, and educational consultants. Students will deepen their “I” perspective by engaging in a curriculum centered on exploring cultural identifiers, working in affinity groups, and connecting with participants from their region to create a strong network for continued leadership at their schools. Our returning participants may seek the opportunity to serve as peer facilitators, taking a critical role in

moving and shaping the dialogue that happens on site, or they may engage in an advanced group called Diversity 201. Our past participants have taken the learning back to their schools to open conversation, jumpstart regional efforts, and educate their peers. In joining us, you will find yourself in a network of some of the most committed student leaders in the country. In Houston, let’s prepare for lift off. Let us lift off the barriers that divide us and tighten the ties that bind us together. Let us lift off the blinders that can make us unaware of the challenges that others face, and let us live in the spirit of interconnectedness that says that justice for all starts with justice for each one. Let us lift off to new ways of thinking and better ways of being as we celebrate the richness of our diverse, global community.

SDLC Welcome

Students are a timeless resource for fresh ideas, new perspective, and healthy challenge. Last year in Philadelphia, more than 1,500 students planted seeds of inclusivity, and returned to their schools renewed by the energy of this powerful and positive collective. Now in its 19th year, the Student Diversity Leadership Conference (SDLC) will travel to Houston and continue to harvest the sustainable legacy of equity and justice that began so many years ago.

We look forward to seeing you in December!

Rodney Glasgow

Oscar Gonzalez

Collinus Newsome-Hutt

Head of Middle School, St. Andrew’s Episcopal School (Maryland) SDLC Chair and Lead Curriculum Facilitator

Program Director, Breakthrough Kent Denver (Colorado) SDLC Lead Logistics Facilitator

Director of Diversity & Senior Instructor, University of Colorado at Boulder – School of Education SDLC Lead Faculty Facilitator

17


The Student Diversity Leadership Conference (SDLC) is an inclusive multiracial, multicultural gathering of upper school student leaders (grades 9-12) from around the country that focuses on self-reflection, allyship, and community building. Led by a diverse team of trained adult and peer facilitators, participants will develop an appreciation of their own identities, build effective cross-cultural communication skills, better understand the nature and development of effective strategies for social justice, and practice expression through the arts, while networking with their peers. In addition to large group sessions, SDLC further creates a safe, supportive environment by organizing participants into cross-sectional teams of 60 known as “family groups,” each of which is led by two adult facilitators. Each family group is further divided into small “home groups,” where intense dialogue and sharing take place, guided by trained peer facilitators, who take a critical role in moving and shaping the experience of all students. SDLC participants will join PoCC participants for the Thursday opening ceremonies and Saturday closing ceremonies. Culminating experiences will include joining together on Saturday morning with PoCC attendees for student-facilitated dialogue sessions designed to explore concepts and themes of equity and justice in our schools. Highly rated in conference evaluations, everyone is encouraged to attend and support these opportunities for cross-generational work.

18

SDLC REGISTRATION SDLC is limited to 1,000 participants who are registered on a first come–first served basis. There is a maximum limit of 9 student registrations per school. It is important that schools complete the registration form for each student fully and accurately to ensure proper communication and placement in family groups. SDLC DELEGATES Schools use a variety of methods to select their participants. Considering that the conference is multiracial and multicultural in its makeup, NAIS encourages schools to create student delegations of up to 9 student leaders that includes under-represented racial/ethnic and cultural groups, are gender-balanced, and have at least one student delegate who has previously attended the conference and is interested in serving as a peer facilitator. In order to fully benefit from the SDLC experience, NAIS strongly suggests that selected delegates are able to attend the conference in its entirety. All SDLC participants, whether local or traveling, must abide by the same rules and expectations. SDLC participants are expected to:

llattend all conference sessions, activities,

and meals; llsign and abide by the Student Conduct Agreement governing behavior throughout the conference; and llcooperate with adult chaperones and with conference staff.


PEER FACILITATORS: SIGN UP ON THE REGISTRATION FORM! Peer facilitators are trained to serve a vital role in our conference by leading their peers in small group dialogues. Peer facilitators receive on-site training for this role, learning and practicing skills that will aid them in their leadership at their schools. Students who would like to serve in this key role and/or have attended SDLC before are eligible to serve as peer facilitators. Please indicate your interest on the SDLC registration form. Students who sign up to be peer facilitators are not eligible to participate in the Diversity 201 family group. Peer facilitators will be trained on-site on Wednesday, December 5, 6:00 – 10:00 PM. Dinner is included. An additional training is scheduled on Thursday, December 6, 7:00 – 7:45 AM for late arrivals. DIVERSITY 201 Returning students not serving as peer facilitators will join an advanced family group called Diversity 201. Diversity 201 is a specialized experience designed to allow returning participants an opportunity to dig deeper into issues of identity, power, privilege and allyship.

SDLC CHAPERONES Schools are required to send a chaperone(s) with their student delegation. Chaperones are expected to:

llattend one of the chaperone orientation

sessions on Wednesday, December 5, 6:00 – 6:45 PM or 9:15 – 10:00 PM at the Hilton Americas – Houston, or Thursday, December 6, 7:00 – 7:45 AM at the George R. Brown Convention Center; llensure students attend all SDLC activities; llarrange for students’ meals not included in the SDLC registration; llbe responsible for their students during conference-designated free times; llmeet students at designated points and times; llsupport and enforce the Student Conduct Agreement, including participation requirements and adherence to curfew; and llbe on call at ALL TIMES during the conference. SDLC MEALS Student delegates will receive lunch and dinner on Thursday, December 6 and on Friday, December 7. Please indicate dietary restrictions on each registration form. Thursday through Saturday breakfasts are not included. Chaperones are expected to have breakfast with delegates. SDLC FORMS SDLC student agreements and medical release forms are available at the end of the conference preview and through the NAIS website. These forms must be downloaded and copied for EACH participating student, completed, and submitted by Wednesday, November 14, 2012. Please also carry copies of EACH form for EACH student with you at all times. 19


Travel Hotel Information Use the attached Hotel Reservation Form or reserve your hotel room through the PoCC site at www.nais.org.

Hilton Americas – Houston 1600 Lamar Street Houston, TX 77010 NAIS has negotiated the following special rates for PoCC and SDLC.

$189.00 per night single occupancy $189.00 per night double occupancy $209.00 per night triple occupancy $229.00 per night quadruple occupancy All rates are subject to applicable city and state taxes, currently at 17%. The deadline to book your hotel is November 5, 2012.

The Hilton Americas – Houston is a AAA Four diamond hotel conveniently located in the heart of downtown Houston and connected to the George R. Brown Convention Center via two indoor skywalks. The hotel is just steps away from Discovery Green Park, Toyota Center, Dynamo Stadium, Houston Pavilion’s premier dining and entertainment center, and Minute Maid Park. Savor dinner at Spencer’s for Steaks and Chops, an award-winning downtown Houston restaurant and wine bar. Work out at the Skyline Spa & Health Club, located on the 23rd floor, and admire stunning city views.

20


Transportation and Parking Taxicabs From George Bush Intercontinental Airport: approximately $55 From William P. Hobby Airport for up to four people per taxi: approximately $22 Parking Hilton Americas – Houston Self parking: $19 daily Valet parking: $30 daily George R. Brown Convention Center The George R. Brown features a 1,600-space parking garage located at the corner of Polk Street and Avenida de las Americas, conveniently connected to the GRB and the Hilton by Level 2 skywalks. Daily parking rates are $10 at the surface lots $12 at the underground Convention District Parking Garage under Discovery Green and $19 at the Hilton Americas – Houston garage. For more information, go to www.houstonconventionctr.com and click on directions and parking.

Rental Car Information There are numerous rental agencies with offices located at the Bush Intercontinental Airport. To get there, follow the Rental Car signage at your arriving terminal and look for the white and maroon buses marked “Rental Car Shuttle.” Check with each rental agency for policies, service and rates. For more information please visit the George Bush International Airport website at www.fly2houston.com. Getting Around Town Houston provides a number of options to assist you in getting out to enjoy all that the city has to offer. Six in the City Taxi Cab $6 taxi ride anywhere in downtown Houston Greenlink Greenlink is a FREE downtown bus service, available Monday – Friday 6:30 AM – 6:30 PM. Metro Rail Houston Set along Main Street, the wallet-friendly rail begins downtown and extends through the Museum District and Texas Medical Center before ending at Reliant Park. Tickets cost $1.25 (one-way) and can be purchased at all rail stops. For more information, visit www.ridemetro.org.

21


PoCC at a Glance George R. Brown Convention Center (CC) Hilton Americas – Houston (HAH) (Subject to Change)

George R. Brown Convention Center (Subject to Change)

Wednesday, December 5, 2012

Wednesday, December 5, 2012

8:00 AM – 12:00 PM School Visits (depart CC) 12:30 – 5:30 PM Houston Food Bank Community Service Project (depart CC) 1:00 – 5:30 PM Star of Hope Mission Community Service Project (depart CC) 9:00 AM – 5:00 PM Adult Leadership Seminar (HAH) 1:00 – 5:00 PM PoCC Affinity Group Training (HAH) 6:00 – 6:45 PM SDLC Chaperone Orientation I (choose one) (HAH) 7:00 – 8:00 PM PoCC Newcomer Orientation (HAH) 9:15 – 10:00 PM SDLC Chaperone Orientation II (choose one) (HAH)

8:00 AM – 12:00 PM School Visits 12:30 – 5:30 PM Houston Food Bank Community Service Project (depart CC) 1:00 – 5:30 PM Star of Hope Mission Community Service Project (depart CC) 6:00 – 10:00 PM Peer Facilitator Training 6:00 – 6:45 PM SDLC Chaperone Orientation I (choose one) 9:15 – 10:00 PM SDLC Chaperone Orientation II (choose one)

Thursday, December 6, 2012 7:00 – 7:45 AM 8:00 – 9:15 AM 9:15 – 10:00 AM 10:00 – 11:15 AM 11:15 AM – 1:00 PM 12:00 – 1:00 PM 1:15 – 3:15 PM 3:45 – 5:00 PM

5:30 – 6:30 PM

SDLC Chaperone Orientation Session II (choose one) (CC) PoCC/SDLC Opening Ceremonies with Helene Cooper (CC) Book Signing and Networking Coffee Break (HAH) Workshop Session A with Featured Speaker Dan Choi (HAH) Lunch Choir Rehearsal (CC) Affinity Group Session I (HAH) Workshop Session B with Featured Speaker Keshni Kashyap (book signing follows) (HAH) PoCC General Session with William Perez (book signing follows) (CC)

Friday, December 7, 2012 8:00 – 9:00 AM 9:00 – 9:45 AM 9:45 – 11:45 AM 11:45 AM – 1:15 PM 12:15 – 1:15 PM 1:30 – 2:30 PM 3:00 – 4:15 PM 4:30 – 5:45 PM 6:00 – 7:00 PM 7:00 – 8:00 PM

PoCC General Session with Kim Phuc (CC) Book signing and Coffee Break (HAH) Affinity Group Session II (HAH) Lunch Choir Rehearsal (CC) State/Regional Meetings (HAH) Workshop Session C with Featured Speaker Steven Jones (HAH) Workshop Session D with Featured Speaker Bernard Harris (HAH) PoCC Reception (HAH) GLBT Reception (TBA)

Saturday, December 8, 2012 Choir Rehearsal (CC) Affinity Group Session III (CC and HAH) 9:30 – 11:00 AM Student-Led Adult/Student Dialogues (by region/state) (CC and HAH) 11:30 AM – 1:00 PM PoCC/SDLC Closing Ceremonies with Baratunde Thurston (book signing follows) (CC)

7:00 – 8:00 AM 8:00 – 9:15 AM

22

SDLC at a Glance

Thursday, December 6, 2012 Peer Facilitator Training for Wednesday Night Late Arrivals 7:00 – 7:45 AM SDLC Chaperone Orientation III (choose one) 8:00 – 9:15 AM PoCC/SDLC Opening Ceremonies with Helene Cooper 9:30 – 11:30 AM SDLC Opening Ceremonies and Family Groups 11:30 AM – 12:30 PM Student Luncheon 1:30 – 3:45 PM Family/Home Groups 3:45 – 4:00 PM Snack Break 4:00 – 5:45 PM Family/Affinity Groups 5:15 – 6:15 PM Student Dinner 7:30 – 8:30 PM SDLC Keynote Presentation with Bernard Harris 8:15 – 10:15 PM Family/Home Groups 10:15 PM Students dismissed to Chaperones 11:00 PM Curfew 7:00 – 7:45 AM

Friday, December 7, 2012 7:00 – 7:45 AM 8:00 – 11:45 AM 12:00 – 1:45 PM 2:00 – 3:45 PM 3:45 – 4:00 PM 4:00 – 6:00 PM 6:00 – 9:30 PM 9:30 – 11:30 PM 11:30 PM 12:00 AM

Breakfast with Chaperones Family/Affinity Groups Student Luncheon and Talent Show Family/Home Groups Snack Break Family/Home Groups Student Dinner, Family Groups, and SDLC Closing Ceremonies Student Dance (movie option provided) Students released to Chaperones Curfew

Saturday, December 8, 2012 Breakfast with Chaperones Affinity Group Session III (Adult/ Student Discussions within race/ ethnicity and gender groupings) 9:30 – 10:45 AM Student-Led Adult/Student Dialogues (by region/state) 11:00 AM – 12:30 PM PoCC/SDLC Closing Ceremonies with Baratunde Thurston

7:00 – 7:45 AM 8:00 – 9:15 AM

PoCC is a registered trademarks of the National Association of Independent Schools.


2012 People of Color Conference (PoCC ®) Adult Registration Please photocopy this form and complete one for each adult attending. (For Group Discounts, send registrations together with one payment.)

  How to register

Participant information PARTICIPANT’S NAME (last, first, middle initial)

Register online at www.nais.org OR

Gender identity (check one) Female

Name as it should appear on badge

Male

Transgender female

Transgender male

Title

Fax this form to (301) 694-5124

Teacher

Dean

Diversity

Assistant

Director

My position at my school is best described as:

Head of School

Board Member

Counselor

Admissions

Other

OR

School/Organization

Mail this form to Sent by U.S. mail: PoCC/SDLC 2012 Registration P.O. Box 4088 Frederick, MD 21705

Assoc. Director

Address

Office Tel.

Home Tel.

On-site cell

Fax Email

Sent by FedEx or any other non-U.S. mail: PoCC/SDLC 2012 Registration 1888 North Market Street Frederick, MD 21701

This will be my (check one)

There is no on-site registration.

The Affinity Group Work is critical to the success of PoCC/SDLC. While certainly optional, to plan for and comfortably accommodate these groups, it is important that each participant indicates the affinity group with which he or she identifies.

For questions about registration, contact us at (866) 229-3691 or NAIS@experient-inc.com.

I do not want my name, school, or Email address listed on the Participant List given to attendees.

!

1st

2nd

3rd

4th

5th

6th

7th

8th

9th

17th

18th

19th

20th

21st

22nd

23rd

24th

25th PoCC

Emergency contact

Cancellation Policy Send registration can­ cellations in writing by November 4, 2012, to the address, fax number, or email address above to receive a full refund less a $50 cancellation fee. No refunds are given after November 4. Cancellations cannot be made over the phone.

Will you need to secure housing?

Dietary Needs: Physical

Vegetarian

Kosher

Shellfish Allergies

13th

14th

15th

16th

This is my school’s first time attending the conference.

Diabetic

I am allergic to:

Please check here if you require special accommodations to participate. Fax a written description of your needs to PoCC/SDLC, NAIS, (202) 973-9790. Yes

No If no, why:

I am a local resident.

I am sharing a room with another attendee.

No overnight stay required.

Conference registration and events Special Events

Registration Rates Member Individual for NAIS, ISAS, and SAES members $600 Early Bird by October 12 $680 Standard by November 12 Member group (5 or more adults from same school, payment received at same time)

$575 Early Bird by October 12 $660 Standard by November 12

Nonmember individual $880 Early Bird by October 12 $960 Standard by November 12

Community Service Opportunities $50 Wed., December 5   H ouston Food Bank 12:30 – 5:30 PM   Star of Hope Mission 1:00 – 5:30 PM

Workshop Presenters $500 Early Bird by October 12 $580 Standard by November 12

Projects will be assigned on a first-come, first-served basis and are subject to availability. A signed waiver is required.

Affinity Group Facilitators $500 Early Bird by October 12 $580 Standard by November 12

Leadership seminar for People of Color and Women $250 Wed., December 5, 9:00 AM – 5:00 PM

School Visit $50 (choose one school) Wed., December 5, 8:00 AM – 12:00 PM

National Association of Independent Schools

Houston

I’m an SDLC Chaperone. 12th

1. Black, African Heritage, Afro-Caribbean Heritage, African American 2. Latino/a Heritage, Hispanic Heritage, Latino/a or Hispanic American 3. East Asian Heritage, Southeast Asian Heritage, South Asian Heritage, Pacific Islander Heritage, East/Southeast/South Asian, Asian American, Heritage from the Indian Sub-Continent 4. First Nations Heritage, Indigenous and Aboriginal People, Native American 5. White, European Heritage, European American 6. Greater Middle Eastern Heritage, Arab Heritage, West Asian Heritage, Middle Eastern or Arab or West Asian American 7. Multiracial Heritage, Multiracial American 8. Transracially Adopted 9. International — Citizens from Countries Outside of the U.S., Recent Arrivals to the United States If different from above, please indicate the affinity group session you wish to attend.

December 6 – 8, 2012

11th

NAME Tel.

Registration Deadline November 12, 2012. Early Bird Deadline October 12, 2012.

People of Color Conference

10th

Discount code: If you were given a discount code for registration, please insert it here.

Payment Visa

AMEX

Awty International School

KIPP Houston

St. John’s School

Total fees enclosed  = $

Check (payable to NAIS)

MC Card #

Name on Card

Exp. Date

Charge my credit card.

Daytime tel.

Signature

All participants are welcome to attend. NAIS has an institutional commitment to the principles of diversity. In that spirit, NAIS does not discriminate in violation of the law on the basis of race, religion, creed, color, sexual orientation, age, physical challenge, national origin, gender, or any other characteristic.

Register online at www.nais.org. Early Bird Deadline: October 12. Registration Deadline: November 12.


2012 Student Diversity Leadership Conference (SDLC™) Registration Please photocopy this form and complete one for each student by November 12. Confirmations for each student will be sent to you once the registration bureau receives the following items: registration form and payment, signed Student Conduct Agreement, and signed Parents’ Authorization and Indemnification Agreement (Medical Release) form. Forms are available in the Virtual Preview and on the PoCC website at www.nais.org.

  How to register

Student information Student’s NAME (last, first, middle initial)

Gender identity (check one) Female

Name as it should appear on badge

SDLC is limited to 1,000 participants who are registered on a first-come, first-served basis. There is a maximum of nine (9) student registrations per school. Register online at www.nais.org OR Fax this form to (301) 694-5124 OR Mail this form to Sent by U.S. mail: PoCC/SDLC 2012 Registration P.O. Box 4088 Frederick, MD 21705 Sent by FedEx or any other non-U.S. mail: PoCC/SDLC 2012 Registration 1888 North Market Street Frederick, MD 21701 There is no on-site registration. For questions about registration, contact us at (866) 229-3691 or NAIS@experient-inc.com. Registration closes November 12, 2012. SDLC Forms due November 14, 2012. Cancellation Policy Send registration can­ cellations in writing by November 4, 2012, to the address, fax number, or email address above to receive a full refund less a $50 cancellation fee. No refunds are given after November 4. Cancellations cannot be made over the phone. Student Diversity Leadership Conference December 6 – 8, 2012 Houston

Home tel.

Male

Transgender female

Transgender male

Student cell student Email

School Name School Address

!

Emergency contact

I am a (check one)

9th

This will be my (check one)

NAME Tel. 10th 1st

11th 2nd

12th grade student 3rd

This is my school’s first time attending the conference.

I do not want my name, school, or Email address listed on the Participant List given to all attendees.

4th SDLC

I am interested in serving as a peer facilitator. (Peer facilitators must be available for training on Weds., December 5, 6:00 – 10:00 PM. Location will be communicated through each school’s sponsor.) I would like to participate in Diversity 201 (For returning participants only — space is limited.). You CANNOT be a Peer Facilitator and participate in Diversity 201. The Affinity Group Work is critical to the success of PoCC/SDLC. While certainly optional, to plan for and comfortably accommodate these groups, it is important that each participant indicates the affinity group with which he or she identifies.

1. Black, African Heritage, Afro-Caribbean Heritage, African American 2. Latino/a Heritage, Hispanic Heritage, Latino/a or Hispanic American 3. East Asian Heritage, Southeast Asian Heritage, South Asian Heritage, Pacific Islander Heritage, East/Southeast/South Asian, Asian American, Heritage from the Indian Sub-Continent 4. First Nations Heritage, Indigenous and Aboriginal People, Native American 5. White, European Heritage, European American 6. Greater Middle Eastern Heritage, Arab Heritage, West Asian Heritage, Middle Eastern or Arab or West Asian American 7. Multiracial Heritage, Multiracial American 8. Transracially Adopted 9. International — Citizens from Countries Outside of the U.S., Recent Arrivals to the United States If different from above, please indicate the affinity group session you wish to attend. Dietary Needs: Physical

Vegetarian

Kosher

Shellfish Allergies

Diabetic

I am allergic to:

Please check here if you require special accommodations to participate. Fax a written description of your needs to PoCC/SDLC, NAIS, (202) 973-9790.

Chaperone/sponsor information Chaperone #1 chaperone #2 contact name contact name ON-SITE cell office tel.

ON-SITE cell office tel.

Email Email Faculty sponsor (For those schools bringing a faculty sponsor in addition to a chaperone.) Faculty Sponsor Office Tel.

Faculty Sponsor Cell Phone

Signature

Conference registration and events Registration Rates

Special Events

Student registration $620 Early Bird by October 12 $670 Standard by November 12 SDLC is limited to 1,000 participants who are registered on a first come-first served basis. There is a maximum limit of nine (9) student registrations per school.

Community Service Opportunities $50 Wed., December 5   H ouston Food Bank 12:30 – 5:30 PM   Star of Hope Mission 1:00 – 5:30 PM

School Visit $50 (choose one school) Wed., December 5, 8:00 AM – 12:00 PM

Awty International School St. John’s School

KIPP Houston

Projects will be assigned on a first-come, first-served basis and are subject to availability. A signed waiver is required. Total fees enclosed  = $

Payment Visa

AMEX

Check (payable to NAIS) MC Card #

Name on Card

Exp. Date

Charge my credit card

Daytime tel.

Signature

Required release signatures HEAD OF SCHOOL

SIGNATURE

Parent/Guardian

SIGNATURE

All participants are welcome to attend. NAIS has an institutional commitment to the principles of diversity. In that spirit, NAIS does not discriminate in violation of the law on the basis of race, religion, creed, color, sexual orientation, age, physical challenge, national origin, gender, or any other characteristic.

Your registration is not complete until you have sent in the Student Conduct Agreement and Medical Release form. Find these forms at the end of the Virtual Preview.


SDLC Student Conduct Agreement For each SDLC participant, we must receive by fax on or before November 14 (1) a Student Conduct Agreement with all required signatures and (2) a signed Parents’ Authorization and Indemnification Agreement (Medical Release Form). This form will not be accepted unless it is complete. School chaperones and administrators should also bring a copy of each form with them to the conference.

SDLC Registration Deadline November 12, 2012. SDLC Forms Deadline November 14, 2012. Remember: SDLC Registrations are limited and will be processed on a first come, first served basis. So don’t delay in submitting your registration and SDLC forms! Student Diversity Leadership Conference

Agreement NAIS and the Student Diversity Leadership Conference (SDLC) faculty and facilitators are pleased that you will attend this year’s conference. You and other students from across the country will take an active role in exploring issues of diversity. We will take a critical look at ourselves, others, and society at large. We will examine the range of diversity, including age, ability, ethnicity, gender, race, religion, sexual orientation, and socio-economic class and we will dialogue on how these identifiers impact cross-cultural communication. We will empower you to develop your own action plans for your school. The skill-building, networking, and exploring of ideas will enable you to develop strategies for creating dialogue in your own school and community. Our goal is to create social justice for and by everyone. We expect that you will take this unique opportunity seriously. These basic rules, designed by students, provide a safe environment and promote optimum participation in the Student Diversity Leadership Conference: 1. Students are expected to abide by the nightly curfew and to remain in their assigned rooms. The curfew on Thursday is 11:00 PM and on Friday is 12:00 AM. 2. Students may meet socially in public areas only. Out of respect and safety, students are not allowed in hotel rooms other than their own. Physical intimacy is strictly prohibited at all times during the conference. 3. The use of alcohol, tobacco, and drugs is strictly prohibited. 4. Cell phones, pagers, and other electronic devices are to be turned off during all conference sessions.

December 6 – 8, 2012

5. Students should anticipate their medical needs and carry medication, sanitary needs, cough drops, etc. at all times since students will not be allowed to leave the SDLC area to retrieve or purchase these items.

Houston

6. Students must attend all conference sessions, meals, and activities. Punctuality is required.

National Association of Independent Schools

Fax to (301) 694-5124 by Wednesday, November 14, 2012

7. During all conference sessions, conference faculty must be informed of the whereabouts of each student participant at all times. Upon dismissal, students are responsible to their chaperones. 8. Respect for the views of peers and the guidance of conference faculty and facilitators is expected. 9. Adherence to community norms and the safeguarding of a sense of community is expected and will enhance conference participation for all. 10. Students and adults who are not registered for the Student Diversity Leadership Conference may not attend any events and may not socialize at the conference site. As representatives of your school, we expect you to work hard, have fun, and dress and act responsibly. Your school and NAIS have placed a great deal of faith in you and feel that you can not only handle the responsibility but will excel individually and collectively. By signing below, you agree to follow these conference rules and understand that violating any of them will result in expulsion from the conference. In the unfortunate event of a student’s expulsion from this conference, the student’s parents are responsible for any additional travel expenses. The student’s school is responsible for completing disciplinary action. The decision of the NAIS Vice President, School Fields Services and Equity and Justice Initiatives, is final.

Signatures All signatures are required prior to a student’s participation in SDLC.

Student Name (print)

School Name

Signature Date

Chaperone’s Name (print)

Signature date

Chaperone’s Email Address

Parent/Guardian’s Name (print)

Signature date

Parent/Guardian’s Email Address

School Administrator’s Name (print)

Signature date

School Administrator’s Email Address

Fax to (301) 694-5124 by Friday, November 14, 2012.


SDLC Parents’ Authorization and Indemnification Agreement

(Medical Release Form)

For each SDLC participant, we must receive by fax on or before November 14 (1) a Student Conduct Agreement with all required signatures and (2) a signed Parents’ Authorization and Indemnification Agreement (Medical Release Form). This form will not be accepted unless it is complete. School chaperones and administrators should also bring a copy of each form with them to the conference.

SDLC Registration Deadline November 12, 2012. SDLC Forms Deadline November 14, 2012. Remember: SDLC Registrations are limited and will be processed on a first come, first served basis. So don’t delay in submitting your registration and SDLC forms! Student Diversity Leadership Conference December 6 – 8, 2012 Houston National Association of Independent Schools

Fax to (301) 694-5124 by Wednesday, November 14, 2012

Agreement The NAIS 2012 Student Diversity Leadership Conference will take place in conjunction with the People of Color Conference in Houston, Texas, December 6 through December 8, 2012. This document is an essential part of the Student Diversity Leadership Conference, serving three important purposes. The first is confirmation that the student whose parents/guardians sign the form is permitted to take part in the Student Diversity Leadership Conference program. The second purpose is to state the agreement of the student’s family and NAIS as to the allocation of the risks of : 1) the student’s travel to and in Houston; 2) living away from home during the conference in an unfamiliar location; and 3) participating in the activities which make up the Student Diversity Leadership Conference Program. The third purpose is confirmation that NAIS has parental authorization to obtain emergency medical care for the student, should such care become necessary during the course of the Student Diversity Leadership Conference Program. Please read the language of these three provisions carefully and do not hesitate to call the Gene Batiste, NAIS Vice President, School Fields Services and Equity and Justice Initiatives, (202) 973-9700 if you have questions. It will not be possible for your child to participate in the 2012 Student Diversity Leadership Conference unless this form is returned with appropriate signatures at all three required locations.

1. Parental Permission To Participate As a custodial parent/guardian of

(please print student’s name), grade

(please provide child’s grade),

from (please provide child’s school), I have given her/him my permission to participate in the NAIS 2012 Student Diversity Leadership Conference. Before signing this permission form, I had the opportunity to satisfy myself as to adequacy and safety of the arrangements for the Student Diversity Leadership Conference. I am familiar with the mental and physical health of my child/ward and his/her ability to travel to unfamiliar places and be exposed to people of different ethnic, cultural, and linguistic backgrounds. My permission for my child to participate is based upon my belief that she/he has the maturity and self confidence to be able to respond appropriately to the challenges which he/she will encounter during the Student Diversity Leadership Conference, as they have been described in the printed materials which I have been given. Signature of Parent/Guardian date Print Full Name of Parent/Guardian

2. Parental Risk Sharing And Indemnification Agreement I recognize that there are risks to my child’s person and property involved in air travel, surface transport and in staying in a hotel in an unfamiliar urban center. I also understand that NAIS could not afford to offer the 2012 Student Diversity Leadership Conference if it was required to bear the sole financial responsibility for those risks. Therefore, in order to induce NAIS to make the 2012 Student Diversity Leadership Conference Program available to my child/ward, I agree to share the risk of loss arising from injury to my child/ward and/or her/his property with NAIS by entering into this indemnification agreement in which I accept responsibility for all losses, except those caused exclusively by the negligence of NAIS and/or its agents. I have reviewed the plans for the Student Diversity Leadership Conference and recognize that use of regularly scheduled airlines or other vehicles to provide transportation between our home and Houston, Texas involves risks to person and property, which may include serious injury and death, and I agree to accept those risks. From my review of the plans for the 2012 Student Diversity Leadership Conference, I am aware that my child/ward will also be exposed to the risks of surface travel in cars, taxis and buses while participating in conference activities, including volunteer activities and I accept the responsibility for those risks. I have reviewed the arrangements for the Student Diversity Leadership Conference and understand that my child will be staying in a hotel in Houston, Texas with other students and their chaperones; and I accept the risk that injury may occur to my child while staying in Houston, Texas. I have also reviewed the description of the day-to-day activities which will take place during the Student Diversity Leadership Conference and recognize that attending conference sessions and community service in Houston and its surroundings will expose my child/ward to the risks inherent in those activities, and I am willing to accept responsibility for those risks. On the basis of my review of the plans for the NAIS 2012 Student Diversity Leadership Conference, and to induce NAIS to allow my child/ward to participate in the Student Diversity Leadership Conference, I, in my capacity as parent/ward of (please print the student’s name), and for myself and my heirs, successors and assigns, agree to indemnify NAIS and its trustees, officers, employees and agents (the “Indemnities”) for any sums of money for which the Indemnities may become liable as a result of any claim, suit or cause of action which I or my heirs, legal representatives, successors and assigns or my child/ward may have, now or in the future, arising out of my child/ward’s participation in the NAIS 2012 Student Diversity Leadership Conference, unless the claim, suit or cause of action arises solely and exclusively from the negligence of the indemnities, which I have not waived or released by signing this form. I have read all of this Parental Risk Sharing and Indemnification Agreement, and I have satisfied myself that I understand what it means. Signature of Parent/Guardian date Print Full Name of Parent/Guardian

3. Medical Treatment Authorization As the parent/guardian of (please print the student’s name), a student participating in the NAIS 2012 Student Diversity Leadership Conference, I authorize physicians and/or other medical personnel, at the direction of NAIS or my child’s chaperone to provide medical care to my child/ward while he/she is away from home and participating in the Student Diversity Leadership Conference, including examining, treating and prescribing medications for her/his care. I understand that NAIS and/or the chaperone will, to the greatest extent possible, consult with me concerning the reasons for and effects of all such care. Recognizing that it may be impossible to reach me in situations in which the physicians treating my child/ward believe that beginning treatment is medically necessary, I authorize NAIS or the chaperone to permit commencement of treatment when, in the professional judgment of the physicians or medical personnel involved, such treatment is medically necessary, even if I/we have not yet been consulted. In authorizing such emergency treatment, I agree to accept the determination of the treating physician or surgeon that the treatment or examination rendered was medically necessary to protect the life, health or mental well-being of my child/ward. I give this authorization on the condition that the treating physician will attempt to contact me, if at all possible, before the treatment or examination is rendered. Signature of Parent/Guardian date Print Full Name of Parent/Guardian My child/ward is entitled to medical insurance benefits under our policy with insurer/HMO.) Our policy is number

(please print the name of your medical (please provide the number of the medical insurance policy number.)

In case of emergency, I can be reached at the following telephone numbers: Daytime Tel.

Cell Phone

Secondary Emergency Contact Print name and relationship

Fax to (301) 694-5124 by Friday, November 14, 2012.

Night Time Tel. Phone Number


2012 PoCC/SDLC Hotel Reservation Form If you wish to book more than one room, please photocopy this form and complete one for each room.

 How to    reserve Your hotel  room Reserve your room by November 5, 2012, in one of the following three ways: Reserve your hotel room online at www.nais.org OR Fax this form to (301) 694-5124 OR Mail this form to Sent by U.S. mail: PoCC/SDLC 2012 Housing Bureau P.O. Box 4088 Frederick, MD 21705 Sent by FedEx or any other non-U.S. mail: PoCC/SDLC 2012 Housing Bureau 1888 North Market Street Frederick, MD 21701 Cancellations There will be a $25 cancellation fee if sleeping rooms are cancelled after October 22, 2012. Changes You are allowed to make up to ten reservations per name. However, you will be required to make name changes no later than November 5, 2012, or all but one of the reser­vations held by the same name and credit card will automatically be cancelled. Attendees cannot reserve rooms by contacting the hotels directly. All reservations must be made via the NAIS Housing Bureau. Questions For questions about hotel reservations, call (301) 694-5243 or (866) 229-3691.

Reservation information I am the room holder making the reservation.

Check one

Mr.

MS.

First Name

Last Name

Title

School/Organization

Student name (if applicable) chaperone name (if applicable)

Address

City

State ZIP country

Office Tel.

Home Tel.

On-site cell

Fax Email

Sharing Room with

First Name

Last Name

First Name

Last Name

First Name

Last Name

Arrival date

Departure Date

Hotel Reservation Please see page 20 for a description of this hotel.

Hilton Americas – H ouston 1600 Lamar Street Houston, TX 77010 NAIS has negotiated the following special rates for PoCC and SDLC. Room Type; please check only one.  $189 per night single occupancy  $189 per night double occupancy  $209 per night triple occupancy  $229 per night quadruple occupancy

All rates are subject to applicable city and state taxes, currently at 17%. Upon receipt of your housing form, the housing bureau will verify room availability. Rooms will be assigned on a first-come, first-served basis and are subject to availability. NAIS receives a $5.00 rebate per room night to help offset convention costs. Room sizes are requests. There is no guarantee that a particular configuration or room type will be available. Please check here if you have special needs. We will contact you to discuss your needs.

Payment A credit card is required to reserve a hotel room even if you wish to pay by check. If you wish to pay by check, you can send your hotel deposit check directly to the hotel after November 5, 2012. Charge my Credit Card.

Visa

AMEX

MC Card #

Name on Card

Exp. Date

Daytime tel.

Signature

Hotel reservation and conference registration are separate. Be sure to register for the conference at www.nais.org.


(18 years and over)

Adult liability waiver

ADULTLIABILITY LIABILITYWAIVER WAIVER ADULT (18 years and older) (18 years and older)

I, on behalf of myself, my personal representatives, assigns, heirs, and next of kin, I, on behalf of myself, my personal representatives, heirs, to and next of kin, ________________________________________, doassigns, hereby agree indemnify and hold ________________________________________, do hereby agree to indemnify and hold harmless the Houston Food Bank, its employees, volunteers or agents (the "Released harmless Houston Food Bank, its employees, volunteers or agents (the Parties")the from any and all claims or causes of action that may arise out of "Released the performance Parties") from any and all claims or causes of action that may arise out of the performance of my assigned duties as a volunteer. I waive any right of action I have against the Released ofParties my assigned duties as aofvolunteer. I waive any of action I have against the Bank. Released in consideration my participation as aright volunteer for the Houston Food Parties in consideration of my participation as a volunteer for the Houston Food Bank. IT IS MY EXPRESS INTENTION AND THE EXPRESS INTENTION OF THE RELEASED ITPARTIESTHAT IS MY EXPRESS INTENTION THE EXPRESS OF THERELEASE RELEASED THE RELEASEAND PROVIDED FOR IN INTENTION THIS AGREEMENT THE PARTIESTHAT THE RELEASE PROVIDED FOR IN THIS AGREEMENT RELEASE THE RELEASED PARTIES FROM THE CONSEQUENCES OF THE ACTS OR OMISSIONS OF THE RELEASED PARTIES FROM THE CONSEQUENCES OF THE ACTS OR OMISSIONS OF THE RELEASED PARTIES, INCLUDING ACTS OF NEGLIGENCE OR ALLEGED NEGLIGENCE, RELEASED PARTIES, INCLUDING ACTS OF NEGLIGENCE OR ALLEGED NEGLIGENCE, AND INCLUDING WHERE SAME ARE THE CONTRIBUTING CAUSE OF THE CLAIM. IT IS AND WHERE SAME CONTRIBUTING OF THE CLAIM. IT IS MY INCLUDING EXPRESS INTENTION ANDARE THE THE EXPRESS INTENTIONCAUSE OF THE RELEASED PARTIES MY EXPRESS INTENTION AND THE EXPRESS INTENTION OF THE RELEASED PARTIES THAT THE INDEMNITY PROVIDED FOR IN THIS AGREEMENT INDEMNIFY THE RELEASED THAT THE INDEMNITY PROVIDED FOR INOF THIS AGREEMENT INDEMNIFYOF THE RELEASED PARTIES FROM THE CONSEQUENCES THE ACTS OR OMISSIONS THE RELEASED PARTIES FROM THE CONSEQUENCES OF THE ACTS OR OMISSIONS OF THE RELEASED PARTIES, INCLUDING ACTS OF NEGLIGENCE OR ALLEGED NEGLIGENCE, AND PARTIES, INCLUDING ACTS OF NEGLIGENCE OR ALLEGED NEGLIGENCE, INCLUDING WHERE SAME ARE A CONTRIBUTING CAUSE OF A CLAIM. AND INCLUDING WHERE SAME ARE A CONTRIBUTING CAUSE OF A CLAIM. I acknowledge that this waiver and release is being signed by me voluntarily, without I acknowledge that this waiverinfluence and release being by me without coercion, duress, or undue andis with fullsigned knowledge ofvoluntarily, its terms and effects. coercion, duress, or undue influence and with full knowledge of its terms and effects. I have read the above waiver and release of liability and fully understand its contents. I have read the above waiver and release of liability and fully understand its contents.

***PLEASE PRINT CLEARLY*** ***PLEASE PRINT CLEARLY*** ________________ _________________ ________________ _________________ First Name Last Name First Name Last Name

__________________________ __________________________ Email Address Email Address

_____________________________________________________________ _____________________________________________________________ Street Street _____________ _____ ________ _____________ _____ City State ________ Zip code City State Zip code Cell Phone: ______________________ Cell Phone: ______________________

Please check if you agree: Please check if you agree:

__ Sure, you can include me on __ Sure, you can include me on Houston Food Bank mail outs Houston Food Bank mail outs ___ Sure, you can text me if my ___ Sure, you can text me if my volunteer shift is adjusted volunteer shift is adjusted

________________________________ ________________________________ Employer / Group Name Employer / Group Name (For internal reference only – this information is used to check for company gift matching programs)

(For internal reference only – this information is used to check for company gift matching programs)

_______________________________ _______________________ _______________________________ _______________________ Signature Date Signature Date **Note: Your personal information WILL NOT be used for solicitations** **Note: Your personal information WILL NOT be used for solicitations**


I, on behalf of the minor child, ________________________________________ (full name I, on behalf of thepersonal minor child, ________________________________________ (full name of minor), his/her representatives, assigns, heirs, and next of kin, of minor), his/her personal representatives, assigns, heirs, and next of kin, ________________________________________ (full name of Parent or Legal Guardian), ________________________________________ of Parent Legalits Guardian), do hereby agree to indemnify and hold harmless(full thename Houston FoodorBank, employees, do hereby agree to indemnify and hold harmless the Houston Food Bank, its employees, volunteers or agents (the "Released Parties") from any and all claims or causes of action volunteers or agents (the "Released Parties") from any and all claims or causes of action that may arise out of the performance of the minor child's assigned duties as a volunteer. may arise out the performance of the the Released minor child's assigned duties as aof volunteer. Ithat waive any right ofof action I have against Parties in consideration my I waive any right action I have against theFood Released participation as aof volunteer for the Houston Bank.Parties in consideration of my participation as a volunteer for the Houston Food Bank. IT IS MY EXPRESS INTENTION AND THE EXPRESS INTENTION OF THE RELEASED PARTIES IT IS MY EXPRESS INTENTION EXPRESS INTENTION OF THETHE RELEASED PARTIES THAT THE RELEASE PROVIDEDAND FORTHE IN THIS AGREEMENT RELEASE RELEASED THAT THE RELEASE PROVIDED FOR IN THIS AGREEMENT RELEASE THE RELEASED PARTIES FROM THE CONSEQUENCES OF THE ACTS OR OMISSIONS OF THE RELEASED PARTIES FROM THE CONSEQUENCES OF THEOR ACTS OR OMISSIONS OF THE RELEASED PARTIES, INCLUDING ACTS OF NEGLIGENCE ALLEGED NEGLIGENCE, AND INCLUDING PARTIES, INCLUDING ACTS OF NEGLIGENCE OR ALLEGED NEGLIGENCE, AND INCLUDING WHERE SAME ARE THE CONTRIBUTING CAUSE OFTHE CLAIM. WHERE SAME ARE THE CONTRIBUTING CAUSE OFTHE CLAIM. IT IS MY EXPRESS INTENTION AND THE EXPRESS INTENTION OF THE RELEASED PARTIES IT IS MY EXPRESS INTENTION AND THE INTENTION OF THE RELEASED PARTIES THAT THE INDEMNITY PROVIDED FOR INEXPRESS THIS AGREEMENT INDEMNIFY THE RELEASED THAT THE INDEMNITY PROVIDED FOR IN THIS AGREEMENT INDEMNIFY THE RELEASED PARTIES FROM THE CONSEQUENCES OF THE ACTS OR OMISSIONS OF RELEASED PARTIES, PARTIES FROM THE THE ACTS OR OMISSIONS RELEASED PARTIES, INCLUDING ACTS OF CONSEQUENCES NEGLIGENCE OR OF ALLEGED NEGLIGENCE, AND OF INCLUDING WHERE INCLUDING ACTS OF NEGLIGENCE OR ALLEGED NEGLIGENCE, AND INCLUDING WHERE SAME ARE A CONTRIBUTING CAUSE OF A CLAIM. SAME ARE A CONTRIBUTING CAUSE OF A CLAIM. The Houston Food Bank also has permission to use the above-reference minor's voice, The Houston Food Bank alsoorhas permission to use the above-reference minor'sFood voice, name, likeness, photograph, videotaped image in publicity about the Houston name,and likeness, photograph, or videotaped image in publicity about the Houston Food Bank its activities. Bank and its activities. I acknowledge that this waiver and release is being signed by me voluntarily, without I acknowledge that waiver and release is being signed byof me coercion, duress, orthis undue influence and with full knowledge itsvoluntarily, terms and without effects. coercion, duress, or undue influence and with full knowledge of its termsits and effects. I have read the above waiver and release of liability and fully understand contents. I have read the above waiver and release of liability and fully understand its contents.

***PLEASE PRINT CLEARLY*** ***PLEASE PRINT CLEARLY*** ________________ __________________ _____________________________ ________________ __________________ _____________________________ First Name Last Name Group Name (if applicable) First Name Last Name Group Name (if applicable) ____________________________________ Please check if you agree: ____________________________________ Please check if you agree: Street Street __ Sure, you can include me on Houston __ Sure, you canouts include me on Houston _____________ _____ ________ Food Bank mail _____________ _____ ________ Food Bank mail outs City State Zip code City State Zip code ___ Sure, you can text me if my volunteer Cell Phone: __________________________________ Cell Phone: __________________________________

___ Sure, you can text me if my volunteer shift is adjusted shift is adjusted

Email Address: ______________________________ Email Address: ______________________________ _______________________________ _______________________ _______________________________ _______________________ Parent/Guardian Signature Date Parent/Guardian Signature Date **Note: Your personal information WILL NOT be used for solicitations** **Note: Your personal information WILL NOT be used for solicitations**

Minor liability waiver

(17 years and under)

(17 years and under)

MINOR LIABILITY WAIVER MINOR LIABILITY WAIVER (17 years and under)


2012 PoCC / SDLC Preview