Youth Summit Registration Form (Please detach and return to the school’s main office by March 18 th.) Name _______________________________________________ School _________________________________ Grade _______ Home Address ________________________________________ City _________________________, NC Zip Code_________ Home Phone _______________ Cell Phone ________________ Emergency Contact Name ________________________________ Relationship __________________________________________ Phone ____________________ Cell Phone _______________ ______________________________________________ (Student or parent address) Any special needs or medical conditions? YesNo Explain ________________________________________________ My child will purchase the $5.00 lunch YesNo For more information contact Todd Henderson at What is the Youth Summit? The Youth Summit is a day long event for 5 th – 8 th grade students. They will be involved in creative activities that will expand their horizons and empower them to be leaders. There will be short, interactive classes for the students, a free Dance, and the 2 nd Annual county-wide Dodge Ball Championship. Who can attend? All 5 th – 8 th grade students enrolled in the Randolph County Schools are invited to attend. (All activities will be divided into 5 th & 6 th grade and 7 th & 8 th grade groups.) What will be there to do? Each student will be able to participate in activities that will teach them life lessons throughout the day. In the afternoon there will be a free Dance or the students can participate in the second annual Randolph County Dodge Ball Championship. (5 th & 6 th grade and 7 th & 8 th grade teams will be separated.) Will there be lunch? Students will be able to either bring their own lunch or they will be able to purchase a Subway sub, chips and drink for $5.00. The money for lunch will be paid during registration the morning of the Youth Summit. How will they get to RHS? Students can be dropped off at Randleman High School after 8:30 a.m. on the 1 st of April. If your child needs transportation to the event, they can be taken to the nearest middle school to be transported to RHS. The buses will leave each middle school at approximately 8 a.m. to RHS and depart RHS at 5 p.m. These students need to have a ride to and from the middle school drop off site on the day of the event if they are riding an activity bus to RHS. Be sure to check on the registration form that transportation is needed. If you will be using transportation, then you must have your registration turned in by March 18, ATMS BRAXTON NERMS SERMS UMS SWRMS If you will require transportation to and from the event, please select a middle school you will be dropped off and picked up from.

- Sponsors - Randolph County School Nurses Randolph County Schools Child Nutrition Dept. Dodge ball Championship Each dodge ball team must have 5 players all from the same school. They must be registered with the Youth Summit in order to be a part of the Dodge Ball Championship. Teams will be separated into 5 th & 6 th grade and 7 th & 8 th grade divisions. Each team must fill out the Dodge Ball team registration form on the next page. ONLY ONE REGISTRATION FORM PER TEAM IS NEEDED. The designated team captain is responsible for completing the team registration. There is limited space in the tournament so get your team registered as soon as possible. Your team must have a name and dress in clothes that represent your school colors. If you have any questions, please feel free to call or Dodge Ball Team Registration Form (Please detach and return to the school’s main office by March 18 th.) Please note if your team will be playing in the 5 TH & 6 TH grade or the 7 TH & 8 TH grade division. Team Name __________________________________________ School ____________________________ Grade Division _____ Team Captain ________________________________________ Player #2 ____________________________________________ Player #3____________________________________________ Player #4 ____________________________________________ Player #5 ____________________________________________ Team Captain Phone Number: ___________________________ - Two divisions – 5 th / 6 th grades and 7 th / 8 th grades - Three minute match time limit - Best out of three (3) games - Double elimination tournament - Rules and bracket of teams will be provided that day. - Space is limited to sixteen (16) teams per division - Team must wear school colors. ALL PLAYERS AND PARENTS MUST SIGN THE DODGE BALL WAIVER FORM (WHICH IS AVAILABLE IN THE SCHOOL’S MAIN OFFICE) IN ORDER TO COMPETE IN THE TOURNAMENT. THE WAIVER MUST BE TURNED IN AT THE SAME TIME WITH YOUR YOUTH SUMMIT REGISTRATION. (SEE REVERSE SIDE)