KEEP SUGAR LAND BEAUTIFUL YOUTH ADVISORY BOARD (KSLB YAB)

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Keep Sugar Land Beautiful Youth Advisory Board (KSLB YAB)

2014 – 2015 Waiver/Application

Thank you for your interest in serving on the Keep Sugar Land Beautiful Youth Advisory Board.
The KSLB Youth Advisory Board Term is one year:

*There is an expectation that current sophomores and juniors will reapply to serve multiple years.

KSLB YAB members must attend all meetings and volunteer at a minimum of 2 KSLB events.

*If you won’t be able to fulfill this commitment, please don’t apply. The success of this board depends on the members. Any member missing a meeting or not volunteering at two KSLB events will be removed from the board.

Please complete this Waiver/Application and return to [email protected] by June 25.
Personal interviews will be conducted in July.
Please type or print legibly. Applicant and Parent Signatures are required.

Name: ______________________________________________________________________________

Address: ____________________________ City: _____________________ Zip Code: ______________

E-Mail: ___________________________ Cell Phone: _______________ Home Phone: ______________

2014-2015 Grade: _______ Age: _________________ Date of Birth: _______ T-Shirt Size: _________

School: ________________________________ School Organization: ____________________________

Teacher: _______________________________ Teacher’s Email: _______________________________

Emergency Contact: ___________________________________________________________________

Name Cell Phone Number

Relationship of Emergency Contact to Student: ______________________________________________

VOLUNTEER WAIVER & PHOTO RELEASE

I agree that I will indemnify and hold harmless Keep Sugar Land Beautiful; its officers, members,

employees, agents, and assigns, from any and all liability or claims of injury of whatsoever nature

which may be incurred by me as a result of my voluntary participation in the KSLB Youth Advisory

Board or any project or event as a Keep Sugar Land Beautiful volunteer.

I consent to and authorize the use and reproduction of any and all photographs which may be taken.

I give Keep Sugar Land Beautiful the right to use my name and photograph in all forms and media

without compensation to me.

I certify that I am eighteen (18) years of age or older, or that my parent or court-appointed guardian

has full knowledge of my participation in the KSLB Youth Advisory Board as well KSLB projects and

events and has given me permission to participate, as evidenced by his/her signature below.

_____________________________________________________________________________________________

Volunteer Participant Signature (If not 18 or older, parent/guardian must co-sign below) Date

____________________________________________________________________________________ Parent/Guardian Signature (Undersigned has read the above and understands this waiver) Date

2014-2015 KSLB YAB Application - Page 2 Name of Applicant______________________________

Please list three strengths that you would bring to the Keep Sugar Land Beautiful Youth Advisory Board:

1_____________________________________________________________________________ 2_____________________________________________________________________________ 3_____________________________________________________________________________

The KSLB mission is “To educate and engage everyone to take responsibility for the environmental health

of our community”. The KSLB YAB will need to develop and complete a project to further the KSLB mission.

Do you have any ideas for a youth board project?

_____________________________________________________________________________________

Meetings are mandatory. I will attend all KSLB YAB meetings: ___________________________________________

KSLB YAB Meetings will generally be held the third Thursday of each month @ 3:00 pm Applicant Signature

List all 2014-2015 extracurricular activities (mentorships, school, community, church, work, etc) in which you will participate:

__________________________________________________________________________________________________________________________________________________________________________

_____________________________________________________________________________________

Please list your leadership positions, volunteer activities, awards or achievements:

_____________________________________________________________________________________

Please list any skills you could bring to the group: (photography, computer skills, writing, public speaking, art, theater, etc.) _____________________________________________________________________________________

_____________________________________________________________________________________

Please list your hobbies:

______________________________________________________________________________________________

Would you be interested in a position as an officer in the 2014/2015 KSLB YAB? Yes _____ No ______

Why would you like to be a member of the KSLB YAB?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Keep Sugar Land Beautiful • 119 Brooks Street • Sugar Land, Texas 77478 • 281-313-5752 • Fax 281-313-5707 • www.kslb.org • [email protected]

A 501 c 3 nonprofit affiliate of Keep America Beautiful and Keep Texas Beautiful

Dedicated to educate and engage everyone to take responsibility for the environmental health of our community

Recipient of multiple Governor’s Community Achievement Awards • Tax ID #76-0628143

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