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Master We Lead.doc
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Participant Emergency Information Form

Insert your logo

Participant Information for We Lead! Program

Participant Name

Home Phone

Address

Name of Parent/Guardian:

Work Phone(s)

Cell Phone(s)

Address (if different from participant)

Home Phone (if different from yours)

Someone to contact in case of emergency, if unable to reach parent/guardian:

Name

Phone

Physician’s Name

Physician’s Phone

Medical Concerns (seizure disorders, diabetes, physical limitations, etc.):

Note: Attach copy of medical insurance card to this form

Participant Contract

Insert your logo We Lead! Participant Contract

As a participant in the We Lead! Program, I agree that…

  • I will attend the program for four days over a three-week period.

  • I will fully participate in all games and activities including discussions and project planning.

  • I will work cooperatively with others.

  • I will treat myself and everyone else in the We Lead! program with the respect due every leader.

  • I will follow decisions made by the group.

  • I will be responsible for the tasks I agree to do for the We Lead! program and the agreed upon community project.

  • I will try out new things knowing I will have the support of other participants and staff persons.

I understand when I complete the program and have successfully followed the terms of this contract, I will receive a stipend of $___ and a We Lead! T-shirt.

Signed:

_______________________________________

Name, We Lead! participant

_______________________________________

Name, participant’s Parent or Guardian (if applicable)

Parent Evaluation of We Lead!

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Parent Evaluation of WE LEAD! (NAME OF YOUR GEOGRAPHIC AREA)!

What difference did participation in We Lead! make for your participants?

What impact was seen in other aspects of the lives of your participants?

What improvements would you suggest to the organizers of We Lead! for next year?

Other Comments

Participant Evaluation of We Lead!

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Participant Evaluation of WE LEAD! (NAME OF YOUR GEOGRAPHIC AREA)!

  1. On scale of 1 to 5, how much new information did you learn about disability rights, awareness and history?

__1_________2___________3_________4__________5__

Nothing A Little Some Lots Tons!

  1. On a scale of 1 to 5, how much new information did you learn about leadership?

__1_________2___________3_________4__________5__

Nothing A Little Some Lots Tons!

  1. During the first week, what was your favorite part of the program?

  1. During the second week, what was your favorite part of the program?

  1. During the third week, what was your favorite part of the program?

  1. What was your favorite part of the program overall and why?

  1. Would you like to participate in WE LEAD! (NAME OF YOUR GEOGRAPHIC AREA)! next year?

  1. What would you change about WE LEAD! (NAME OF YOUR GEOGRAPHIC AREA)!?

  1. What advice would you give to next year’s WE LEAD! (NAME OF YOUR GEOGRAPHIC AREA)! participants?

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