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GEAR UP Director Chaperone Approval Form | 2026 Youth Leadership Summit

*This form must be signed by the director of the GEAR UP grant. Complete one form, regardless of the number of chaperones.  

By signing below, I acknowledge that I understand the role of the chaperone at the 2026 Youth Leadership Summit and that I have discussed the chaperones’ responsibilities listed below with every person I approved to be a chaperone:  

  • Register for the conference as a regular conference attendee. If a chaperone does not register for the conference, they will not be able to attend any conference events, including meals and the Wednesday Youth Leadership Summit Plenary Session.  
  • Ensure the students’ safe arrival to and from the conference hotel.  
  • Supervise student(s) at all times when the students are not participating in Youth Leadership Summit activities, including dropping off and picking up students at the designated times in the Youth Leadership Summit schedule.  
  • Do not allow the student(s) to wander around the hotel on their own or leave the hotel unaccompanied by a chaperone or other designated adult member of your GEAR UP staff team. The curfew for students is at 11:00 PM each night.  
  • Be timely in going to the Youth Leadership Summit training room to drop students off and pick them up at the designated times. Chaperones should have a government-issued ID for check-in and check-out.   
  • Be proactive and clear in communicating with NCCEP staff and the Youth Leadership Summit trainers if a student is unable for any reason to attend a training session or if there are any other issues of concern.  
  • Serve as an on-site emergency contact in the event of a medical emergency, a student not feeling well, a behavior issue, or for any other reason where a student is unable to participate in the Youth Leadership Summit, including picking up the student if/as needed and requested by NCCEP staff.  
  • Chaperones must have their phones charged and on their person at all times during Youth Leadership Summit training times, in case of emergency. Chaperones must answer or respond in a timely manner to all calls or texts from NCCEP staff members. Staff numbers will be located in the chaperone packet provided at the chaperone orientation.  
  • Read all communication from NCCEP about the Youth Leadership Summit and participate if/as directed in an NCCEP orientation for Youth Leadership Summit chaperones.  
  • Ensure students are dressed per the Youth Leadership Summit dress code.  
  • Attend the closing ceremony of students located in the Youth Leadership Summit training room, following the conclusion of Wednesday sessions, if possible.  
  • In column A, below, list each person who is an approved chaperone.  
Important Notes: 
  • If someone is not listed below, they will not be allowed to pick up students. Chaperones can be responsible for multiple students – make sure to list each chaperone that will be responsible for each student.  
  • Chaperones may only be added on-site at the conference with director approval.  
  • Make sure to provide the complete contact information for each chaperone on the enrollment form.  
  • Make sure that the information on this sheet matches the information on the enrollment form. Please notify NCCEP of any changes in chaperones or chaperone contact information.  
  • In column B, list each student (full name) that the chaperone(s) in column A is/are authorized to pick up, drop off, and chaperone when the Youth Leadership Summit is not in session. 
Please list the names of all your chaperones and the corresponding students they will be responsible for on site. 

*Type each chaperone’s full name, below. You can list more than one approved chaperone for each group of students. 

*List each student (full name) that the chaperone(s) is/are authorized to pick up, drop off, and chaperone when the Youth Leadership Summit is not in session. 
1. Chaperone #1 
List student(s) by full name that Chaperone is responsible for.
2. Chaperone #2
List student(s) by full name that Chaperone is responsible for.
3. Chaperone #3 
List student(s) by full name that Chaperone is responsible for. 
4. Chaperone #4
List student(s) by full name that Chaperone is responsible for.
5. Chaperone #5
List student(s) by full name that Chaperone is responsible for.
6. Chaperone #6
List student(s) by full name that Chaperone is responsible for.
7. Chaperone #7
List student(s) by full name that Chaperone is responsible for.
8. Chaperone #8
List student(s) by full name that Chaperone is responsible for.
9. Chaperone #9
 
List student(s) by full name that Chaperone is responsible for.
10.  Chaperone #10
 
List student(s) by full name that Chaperone is responsible for.
12. Director Signature *This question is required.
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