dac 2013 registration packet #1

DAY AT THE CAPITOL 2013 Dear CYC Chapters! The Sacramento Chapter & Statewide office looks forward to seeing your chapter at the upcoming Day at the Capitol conference! Our Day at the Capitol conference is open to all CYC chapters (members and supporters). Registration for the conference covers all meals (Saturday Dinner‐Monday Breakfast), and all conference related activities. Monday lunch is on your own so please plan accordingly. Please reserve your rooms ASAP! You can hold your rooms on a credit card WITHOUT the card being charged, and can increase or decrease the number of rooms as you get closer to the conference date. What you will need to complete registration: 1. Full names of youth and supporters attending the conference. 2. Names, gender, and ages of all youth, t‐shirt size (if there is a t‐shirt this year) dietary restrictions, accommodations that are needed, and how many years they have attended CYC's DAC in the past. 3. The name of the person representing the chapter in the Media and Rally workshop. 4. Indication of which payment option will be used to cover registration. WHEN: Saturday January 26th ‐ January 28th, 2013. Registration will start be from 11am ‐ 1pm on Saturday January 26th. Conference will end Monday January 28th at 4pm. Please plan your travel accordingly. Conference agenda will be sent to all chapters soon. WHERE: Holiday Inn‐ Sacramento, California Address: 300 J Street. Sacramento, CA. 95814 Phone: 916‐446‐0100 REGISTRATION & LODGING INFORMATION: Early Bird Conference Registration Deadline: Friday, January 4th, 2013 REGISTRATION FEE: $190.00 Per Person. After January 4th, 2013 registration fees are non‐refundable. If you would like to add another person after this deadline date, the late registration fee will be $225.00 per person. Holiday Inn Room Reservation Deadline: Friday, January 4th, 2013 (after this date, rooms and rates are not guaranteed). HOTEL ROOMS: $123.58 Per Room, Per Night‐ this rate includes all taxes. Please call the registration line at 916‐446‐0100 and reserve under the California Youth Connection room block, using the group code UYY or go to the website for online registration: www.sacramentoHI.com PARKING AT HOLIDAY INN: $14 per day. LATE REGISTRATION FEE (AFTER JANUARY 4th): $225.00 per person. Registration closes Friday January 11th, 2013. After January 4th, 2013 registration fees are non‐refundable. You are allowed to substitute for individuals. If you would like to add another person after this deadline date, the late registration fee will be $225.00 per person. Look forward to seeing your chapter at the upcoming DAC conference!

DAC 2013 is proudly sponsored by

Member Emergency Contact Form

Emergency Contacts

Youth's name: Parent's/guardian's

name:

Age: Home phone:

Date of birth: Work phone:

Cell phone:

Medical conditions: Alternate contact's

name:

Allergies: Home phone:

Current medications: Work phone:

Cell phone:

Family doctor: Alternate contact's

name:

Doctor's phone: Home phone:

Work phone:

Cell phone:

Notes:

Photograph/Video Release Form

I hereby give permission for the California Youth Connection (CYC) to use, adapt, modify, reproduce and distribute any

photograph(s)/video taken of me to promote, publicize and advertise our mission and its programs and services. I agree

that California Youth Connection owns the copyright in these photographs, and I give my permission for these

photographs to appear in newspapers and in CYC's brochures, publications, presentations, website, press releases, and

videos. I also understand that this is a public event and my picture may appear on the news or newspaper. I waive all

rights including any right to inspect or to approve the photographs or finished versions of any materials incorporating the

photographs, including written copy that may be created and appear in connection with the photographs, and I give the

CYC the right to change, crop, or otherwise alter the photographs for these materials.

On my behalf, I hereby release CYC, its agents, employees, licensees and assigns, from any claims and liabilities arising

out of CYC's use of these photographs and video, including claims for financial compensation now and in the future and

for invasion of privacy, right of publicity, defamation, or libel. This waiver includes both known claims and those claims

identified in California Civil Code Section 1542 which I may not yet know to exist.

I understand that my name and Chapter may appear in CYC newsletter, materials and videos.

***This form grants permission for CYC to use your name and pictures/video without prior approval for the purposes of

carrying out our mission.

Signed: ____________________________________________ Date: _______________________

Parent/Social Worker Signature __________________________________________________

Print Name: ______________________________________________________________________

Street Address: ____________________________________________________________________

City, State, Zip Code: _______________________________________________________________

E-mail Address: ___________________________________________________________________

All personal contact information will remain confidential and

will not be shared or sold to any third parties.

SCHOLARSHIP APPLICATION DUE - FRIDAY, DECEMBER 7, 2012

The CYC Statewide Office has established a small scholarship fund to increase youth attendance for the upcoming Day at the

Capitol Conference in Sacramento. The scholarship can cover a youth or supporter travel, registration fee, lodging, or other costs

pertaining to the conference. If your chapter would like to nominate someone for this scholarship opportunity, please fill out the

information below and return it to your Regional Coordinator by Friday, December 7, 2012. Late applications will not be considered.

Applicants will be selected using the criteria guidelines set by our Advisory Board (see below). Please call your Regional

Coordinator if you have any questions regarding this scholarship opportunity.

Regional Coordinator Comment:

2013 CYC Day at the Capitol

Scholarship Request Form

Please complete the section below and return this form to your outreach coordinator.

Today’s Date: _______________________ Chapter: ____________________________

Total Amount Requested: _________________ Total # of Scholarship Applicants: ___________

Name Youth or Supporter: ___________________________ Check all that applies: ___ Registration Fee $190 ___ Lodging $123.58 ___ Travel $_________

Name Youth or Supporter: ___________________________ Check all that applies: ___ Registration Fee $190 ___ Lodging $123.58 ___ Travel $_________

SCHOLARSHIP GUIDELINES

Registration Fee: $190 per person Lodging: $123.58 per night (taxes included)

1. The scholarship will be distributed among chapters in Northern, Bay Area, Central Valley, and Southern regions. 2. Scholarships will be awarded to members and supporters who demonstrate the greatest need. 3. Scholarship funds can be used for both youth and supporters to pay for conference costs. 4. All costs may not be covered due to the limited amount of scholarship funds available.

CALIFORNIA YOUTH CONNECTION

DAY AT THE CAPITOL 2013

FACILITATOR APPLICATION

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OVERVIEW

California Youth Connection (CYC) provides the opportunity for youth to gain facilitation

skills and apply them by becoming facilitators during our annual conferences. Please read this

application thoroughly and answer all questions under the application portion. Make sure you

are qualified to be a facilitator (see qualifications below) before you submit this application.

Facilitator applications are due Monday, December 3, 2012. All applicants will be notified

by Monday, December 10, 2012.

WHAT IS DAY AT THE CAPITOL (DAC)?

Each year, CYC holds an advocacy and empowerment event called the Day at the Capitol

(DAC) conference! At Day at the Capitol youth are trained on the legislative process and have

the opportunity to meet with members of the legislature to discuss their ideas for improving

the foster care system. During the first two days of the event, youth attend workshops that

prepare them to effectively communicate with legislators. Youth facilitators run the workshops

providing members with a deeper understanding of the legislative issues and build excitement

and confidence before meeting with legislators on Monday.

WHAT IS T4T?

CYC offers training for trainers (T4T) to help prepare facilitators for their workshops at the

conference. At the T4T, CYC staff train the group on facilitation skills (how to lead a group in

a discussion, communication skills, how to write flipcharts, etc), teach the future trainees on our

training curriculum (or manual) to run during their workshops, and show members new

techniques to build leadership skills.




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QUALIFICATIONS

YOU MUST BE ATTENDING THE ENTIRE CONFERENCE WITH YOUR

CHAPTER!!! This means that the chapter must approve you to attend to the upcoming

conference. The chapter will be responsible for your travel to the conference, hotel room at the

conference, and registration for the conference (includes meals). The 2012 Day at the Capitol

Conference is scheduled to occur Saturday, January 26th through Monday, January 28th.

2013.

YOU MUST ATTEND the Training for Trainers (T4T) to help prepare you to be a

facilitator at the conference. This training will occur Friday, January 11th through Sunday

January 13, 2013 (all costs and travel for the T4T will be paid by CYC).

WHAT IS A FACILITATOR?

The workshops at the upcoming conference help prepare our youth members for visits with

their legislators on the Monday of the conference. Below you will find a few key roles

facilitators play in preparing our members to present:

• A facilitator is somewhat like a teacher and assists their group in learning.

• Helps our members to understand the common goals are in their workshops.

• Prepares members by educating them about the issues they will discuss.

• Uses different skills and techniques to help members brainstorm their ideas.

A facilitator:

• is able to stay on task

• is friendly

• is enthusiastic

• arrives on time

• is committed to the cause

• has a desire to learn

• is helpful

• is motivated

• knows when to ask for assistance

• is confident

• is mature

• is passionate




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LEGAL NAME: ______________________ DATE OF BIRTH: _____________________ CHAPTER: ___________________ PHONE #’S: __________________________________ EMAIL: _____________________________________________________________________ MAILING ADDRESS: _________________________________________________________

1. Have you received approval from your CYC chapter to be a facilitator at the upcoming conference? This means you will be attending the conference with your chapter; your chapter will be paying for your travel & registration fees for the conference. Please have your chapter chair and one supporter who will be attending the conference fill out the section below. CHAPTER CHAIR

Yes, our chapter has approved the person above to become a facilitator for the upcoming conference. (Check Circle) Chapter Chair: X____________________ X_____________________ X___________ (Please Print) (Signature) (Date) CHAPTER SUPPORTER Yes, I approve the person named above to become a facilitator for the upcoming conference. (Check Circle) Supporter: X____________________ X_____________________ X___________ (Please Print) (Signature) (Date) 2. Have you attended a CYC conference before?




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3. Have you ever facilitated at a CYC conference before? Which one? If you have not, please list any activities/leadership skills you have that would help you facilitate at this conference. 4. If you are still in foster care, have you notified your foster parent/guardian of your intent to facilitate at this conference and informed them of both the T4T & conference dates. If no, please explain. If yes, please have your care provider sign and date. Care Provider: X____________________ X_____________________ X___________ (Please Print) (Signature) (Date) Care Provider Contact Information Phone number: _______________________ 5. Are you a part of the Youth Training Project (YTP)? PLEASE EMAIL THIS FORM TO CHANTEL JOHNSON at [email protected]. Faxing the form is an option but please call or email ahead of time (the fax is shared).

Check with Chapter for approval. Make sure chapter approves member becoming a facilitator and ensure member will be attending the conference with their chapter (registration & travel costs will be covered by chapter). Check box if approved by chapter.

Contact facilitator and notify them of their application outcome.

Approved: ____________ Denied: ______________ (check one) Date Contacted member regarding application outcome: __________

mailto:[email protected]

dac 2013 registration packet #1

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