Leadership Event Host Acknowledgment
Please complete this form to acknowledge your responsibilities and consent to host a leadership event.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization/Group Affiliation
*
Event Name
*
Event Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Event Location
*
What is your role in the event?
*
Please Select
Primary Host
Co-Host
Event Coordinator
Volunteer Leader
Other
Please indicate your understanding of the following host responsibilities:
*
Rows
I understand and accept
Arriving on time and prepared
1
Ensuring participant safety
2
Following event guidelines
3
Communicating with the organizing team
4
Reporting any incidents promptly
5
Do you feel adequately prepared to fulfill your responsibilities as a host?
*
Yes
No
Not sure
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please provide your signature to confirm your acknowledgment and agreement.
*
Acknowledge and Submit
Acknowledge and Submit
Should be Empty: