Leadership Connect Enrollment
This enrollment form is for new students to enroll in Leadership Connect and join 21st Century Leaders, gaining access to our online learning platform (LC) as well as to all our school-year leadership training events.
Step 1 of 10
Student Information
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First Name
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A. R. Johnson Health Science and Engineering Magnet School
Academy for Classical Education
Acellus Academy
Alcovy High School
Alexander High School
Allatoona High School
Alliance Academy for Innovation
Alpharetta High School
Americus-Sumter High
Americus Sumter County High South
Apalachee High School
Appling County High School
Arabia Mountain High School
Archer High School
Armuchee High School
Athens Academy
Atlanta Classical Academy
Atlanta Girls' School
Atlanta International School
B.E.S.T. Academy
Bacon County High School
Baker County High School
Baldwin High School
Banneker High School
Ben Franklin Academy
Benjamin E. Mays High School
Berkmar High School
Berrien High School
Blair Academy
Blessed Trinity Catholic High School
Booker T. Washington High School
Bradwell Institute
Bremen High School
Brooks County High School
Brookstone School
Brookwood High School
Buford High School
Burke County High School
C.A. Gray Junior High School
Cairo High School
Calhoun County High School
Calhoun High School
Callaway High School
Calvary Day School
Cambridge High School
Campbell High School (Smyrna)
Capstone Academy
Carter High School
Cartersville High School
Carver Early College
Carver High School (Atlanta)
Carver STEAM Academy
Cass High School
Cedar Grove High School
Cedar Shoals High School
Cedartown High School
Celina High School
Centennial High School
Central Gwinnett High School
Central High School (Bibb County)
Central High School (Carroll County)
Chamblee High School
Chapel Hill High School
Charles R. Drew Charter School (Atlanta)
Charles R. Drew High School (Riverdale)
Chatham Hall
Chattahoochee County High School
Chattahoochee High School
Cherokee High School
Chestatee High School
Clarke Central High School
Clarkston High School
Clinch County High School
Cobb Horizon High School
Coffee High School
Collins Hill High School
Colonial Hills Christian
Colquitt County High School
Columbia High School
Columbus High School
Commerce High School
Community Christian School
Coosa High School
Coretta Scott King Young Women's Leadership Academy High School
Cornerstone Preparatory Academy
Counterpane
Covenant Christian Ministries Academy
Creekside High School
Crisp County High School
Cristo Rey Atlanta Jesuit School
Cross Creek High School
Cross Keys High School
Dacula High School
Dade County High School
Dalton High School
Darlington School
Davidson Fine Arts Magnet School
Dawson County High School
Decatur High School
Deerfield-Windsor School
DeKalb Early College Academy
DeKalb School of the Arts
Denmark High School
Destiny Achiever's Charter High School
Discovery High School
Dodge County High School
Dooly County High School
Douglas County High School
Drew Charter Senior Academy
Druid Hills High School
Dublin High School
Duluth High School
Dunwoody High School
Dutchtown High School
Eagle's Landing High School
Eagles Landing Christian Academy
Early County High School
East Coweta High School
East Forsyth High School
East Jackson Comprehensive High School
East Paulding High School
Eastside High School
Edmund Burke Academy
Effingham County High School
Elite Scholars Academy
Emanuel County Institute
Etowah High School
Evans Christian Academy
Evans High School
Excel Christian Academy
Fayette County High School
Flowery Branch High School
Forest Park High School
Forsyth Central High School
Franklin County High School
Franklin Virtual High School
Frederick Douglass High School
Fugees Academy
Fulton Leadership Academy
Fulton Science Academy High School
G. W. Carver High School
G.W. Carver High School (Columbus)
Gainesville High School
George Walton Comprehensive High School
Georgia Connections Academy
Georgia Cyber Academy
Gilmer High School
Global Impact Academy
Glynn Academy
GMC Prep HS
Grayson High School
Greater Atlanta Adventist Academy
Greater Atlanta Christian School
Greenbrier High School
Griffin High School
Grovetown High School
Gwinnett School of Mathematics, Science, and Technology
H.V. Jenkins High School
Habersham Central High School
Hancock Central High School
Hapeville Charter Career Academy
Haralson County High School
Hardaway High School
Harlem High School
Harris County High School
Harrison High School
Hart County High School
Harvester Christian Academy
Henry County High School
Heritage Academy
Heritage Classical Study Center
Heritage High School
Hillgrove High School
Hiram High School
Holy Innocents' Episcopal School
Holy Spirit Prep School
Homeschool/Georgia Virtual School
Hope Christian Academy
Houston County High School
Howard High School
Impact Academy
Innovation Academy
Jackson High School
James Madison High School
Jeff Davis High School
Jefferson County High School
John Milledge Academy
Johns Creek High School
Johnson Ferry Christian Academy
Johnson High School
Jonesboro High School
Jones County High School
Jordan Vocational High School
Kell High School
Kendrick High School
Kennesaw Mountain High School
Killian Hill Christian School
King's Academy
Kings Ridge Christian School
KIPP Atlanta Collegiate High School
Konos Academy
LaGrange High School
Lake Oconee Academy
Lakeside High School (Atlanta)
Lakeside High School (Evans)
Lakeview Academy
Lamar County High School
Lambert High School
Landmark Christian School
Langston Hughes High School
Lanier County High School
Lanier High School
Lassiter High School
Lee County High School
Liberty County High School
Lithia Springs High School
Lithonia High School
Locust Grove High School
Loganville High School
Long County High School
Lovejoy High School
Lovett School
Lowndes High School
Luella High School
Madison County High School
Marietta High School
Marion County Middle/High School
Marist School
Martha Ellen Stilwell School of the Arts
Martin Luther King Jr. High School
Mary Persons High School
Maynard Jackson High School
McEachern High School
McIntosh County Academy
McIntosh High School
McNair High School
Midtown High School
Mill Creek High School
Miller Grove High School
Milton High School
Mitchell County High School
Model High School
Mohammed School of Atlanta
Montgomery County High School
Morgan County High School
Morrow High School
Mountain View High School
Mount Pisgah Christian School
Mount Vernon Presbyterian School
Mt. DeSales Academy
Mt. Zion High School
Mundy's Mill High School
Murray County High School
New Hampstead High School
New Manchester High School
Newnan High School
Newton High School
Norcross High School
North Atlanta High School
North Clayton High School
North Cobb Christian School
North Cobb High School
Northeast Independent Preparatory Academy
North Forsyth High School
Northgate High School
North Georgia Christian Academy
North Gwinnett High School
North Hall High School
North Oconee High School
North Paulding High School
Northside High School
North Springs Charter High School
Northview High School
Northwest High School
Northwest Independent Preparatory Academy
Notre Dame Academy
Oglethorpe County High School
Ola High School
Our Lady of Mercy Catholic High School
Pace Academy
Parkview High School
Paulding County High School
Paul Duke STEM High School
Peach County High School
Peachtree Academy
Peachtree Ridge High School
Pebblebrook High School
Pepperell High School
Perry High School
Phillips Exeter Academy
Pickens High School
Pike County High School
Pinecrest Academy
Pinewood Christian Academy
Pope High School
Prince Avenue Christian School
Providence Christian Academy
Provost Academy Georgia
Putnam County High School
Rabun County High School
Redan High School
Richmond County Technical Career Magnet
Richmond Hill High School
Ringgold High School
Riverdale High School
River Ridge High School
Riverside Military Academy
Riverwood International Charter School
Rockdale County High School
Rockdale Magnet School for Science and Technology
Rome High School
Ronald E. McNair High School
Roswell High School
Rutland High School
Saint Mary's School
Salem High School
Sandy Creek Highschool
Sandy Creek High School
Savannah Arts Academy
Savannah Early College
Screven County High School
Seckinger High School
Sequoyah High School
Shaw High School
Shiloh High School
Social Circle High School
Sonoraville High School
South Atlanta High School
South Cobb High School
South Effingham High School
South Forsyth High School
South Gwinnett High School
South Paulding High School
Southwest Atlanta Christian Academy
Southwest DeKalb High School
Southwest Georgia Academy
Southwest High School
Spalding High School
Sprayberry High School
St. Anne-Pacelli Catholic School
St. Pius X Catholic High School
St. Vincent's Academy
Starrs Mill High School
Stephenson High School
Stockbridge High School
Sumter County High School
Swainsboro High School
Taliaferro County High School
Telfair County High School
The Blackstone Academy
The Campus
The Darlington School
The Galloway School
The Hotchkiss School
The LIFE School
The New School
The New Schools at Carver
The Paideia School
Therrell High School
The Walker School
The Weber School
Thomson High School
Tiftarea Academy
Tift County High School
Tri-Cities High School
Troup County Comprehensive High School
Tucker High School
Twiggs County High School
Union County High School
Union Grove High school
Unity Christian School
Utopian Academy for the Arts High School
Valdosta High School
Valwood School
Veterans High School
Vidalia High School
W.D. Mohammed High School
Walnut Grove High School
Walton High School
Ware County High School
Warren County High School
Wayne County High School
Wesleyan School
West Forsyth High School
West Hall High School
Westlake High School
West Laurens High School
Westminster Schools
Westover High School
Westridge Christian
Westside High School
Wheeler High School
Whitewater High School
William and Reed Academy
Windsor Forest High School
Wisdom Academy
Woodberry Forest
Woodland High School
Woodstock High School
Woodville Tompkins High School
Woodward Academy
Young Americans Christian School
Other
Re-enter your email address to confirm it.
Street
City
State
ZIP Code
Lee
Bibb
Clay
Cobb
Cook
Dade
Hall
Hart
Long
Pike
Polk
Tift
Ware
Bacon
Baker
Banks
Bryan
Burke
Butts
Crisp
Dodge
Dooly
Early
Evans
Floyd
Glynn
Grady
Heard
Henry
Irwin
Jones
Lamar
Macon
Peach
Rabun
Towns
Troup
Union
Upson
Wayne
White
Worth
Barrow
Bartow
Brooks
Camden
Clinch
Coffee
Coweta
Dawson
DeKalb
Echols
Elbert
Fannin
Fulton
Gilmer
Gordon
Greene
Harris
Jasper
Lanier
Marion
Miller
Monroe
Morgan
Murray
Newton
Oconee
Pierce
Putnam
Schley
Sumter
Talbot
Taylor
Thomas
Toombs
Turner
Twiggs
Walker
Walton
Warren
Wilcox
Wilkes
Appling
Baldwin
Berrien
Bulloch
Calhoun
Candler
Carroll
Catoosa
Chatham
Clayton
Decatur
Douglas
Emanuel
Fayette
Forsyth
Hancock
Houston
Jackson
Jenkins
Johnson
Laurens
Liberty
Lincoln
Lowndes
Lumpkin
Madison
Pickens
Pulaski
Screven
Stewart
Telfair
Terrell
Webster
Wheeler
Atkinson
Ben Hill
Bleckley
Brantley
Charlton
Cherokee
Colquitt
Columbia
Crawford
Franklin
Glascock
Gwinnett
Haralson
McDuffie
McIntosh
Mitchell
Muscogee
Paulding
Randolph
Rockdale
Seminole
Spalding
Stephens
Tattnall
Treutlen
Chattooga
Dougherty
Effingham
Habersham
Jefferson
Whitfield
Wilkinson
Jeff Davis
Meriwether
Montgomery
Oglethorpe
Taliaferro
Washington
Athens-Clarke
Augusta-Richmond
Georgetown-Quitman
Cusseta-Chattahoochee
First Name
Last Name
Suffix
Re-enter your email address to confirm it.
First Name
Last Name
Suffix
11
1010
Where 1 is "not really a leader" and 10 is "I am the best leader ever"
11
1010
Where 1 is "I have no idea what career I want to pursue" and 10 is "I know exactly what I want to do"
11
55
Where 1 is "I'm not trained in this competency" and 5 is "I understand this skill and use it competently"
11
55
Where 1 is "I'm not trained in this competency" and 5 is "I understand this skill and use it competently"
11
55
Where 1 is "I'm not trained in this competency" and 5 is "I understand this skill and use it competently"
11
55
Where 1 is "I'm not trained in this competency" and 5 is "I understand this skill and use it competently"
11
55
Where 1 is "I'm not trained in this competency" and 5 is "I understand this skill and use it competently"
11
55
Where 1 is "I'm not trained in this competency" and 5 is "I understand this skill and use it competently"
11
55
Where 1 is "I'm not trained in this competency" and 5 is "I understand this skill and use it competently"
0
1-2
3-4
5+
You are your parent/guardian must read this section carefully.
In consideration of 21st Century Leaders' allowing the "Student" to participate in any 21st Century Leaders Program (including, but not limited to Leadership Connect, Summer Leadership Institutes, fall and winter summits, 21CLubs, Georgia Youth Leadership Awards, school-year workshops and/or service projects, and any additional 21CL branded trainings where registration is required), I, the parent/guardian, for myself and on behalf of the Student and our respective heirs, executors, administrators and assigns (in each instance, the "Executing Party"), shall defend, indemnify, release and hold harmless 21st Century Leaders (including its directors, officers, agents, employees, representatives, volunteers, successors and assigns) against any and all suits, actions, or proceedings, at law or in equity, and from any and all claims, demands, losses, judgments, fines, penalties, damages, costs, expenses, or liabilities whatsoever, that arise from or relate to the Student's participation in the Program. Further, Executing Party hereby releases and forever discharges 21st Century Leaders (including its directors, officers, agents, employees, representatives, volunteers, successors and assigns) from any liability arising from or relating to the Student's participation in the Program.
Executing Party acknowledges that it is his or her responsibility to consult with a physician with respect to any past or present injury, illness, health problem or any other condition or medication that may affect Student's ability to safely participate in the activities of 21st Century Leaders. Executing Party further acknowledges that as an inducement for 21st Century Leaders to allow access to the Program, Student has to abide by all rules and instructions of 21st Century Leaders (collectively, the "Rules"). Failure to follow the Rules or any other act or omission by Student, as determined in the sole discretion of 21st Century Leaders, will result in termination of access to the Program.
Executing Party understands that the Program may involve activities that may be hazardous to the Student and inherently dangerous, including but not limited to being exposed to infectious diseases such as COVID-19 (collectively "Infectious Diseases" and each an "Infectious Disease"). Executing Party hereby expressly and specifically assumes the risk of damage, injury, harm or death in connection with the Program.
Executing Party acknowledges that an inherent risk of exposure to Infectious Diseases exists in any public place where people are present. By allowing the Student to participate in the Program, Executing Party agrees that the Student will (a) comply with all directives and requirements of 21st Century Leaders or any applicable governing body, agency or similar institution, as determined by 21st Century Leaders, (b) abstain from participating in the Program or coming into contact with any released parties stipulated above or participants of the Program if feeling unwell or having been exposed to an Infectious Disease or an individual infected with an Infectious Disease (c) submit to a temperature check(s) or other procedures before participating or entering any designated premises by 21st Century Leaders, (d) oblige with social distancing and other protocols, (e) frequently wash hands and/or use hand sanitizers, and (f) wear masks, covering nose and mouth as directed by 21st Century Leaders.
Executing Party will not initiate any claim, lawsuit, court or agency action, or other legal proceeding or demand against 21st Century Leaders, nor join or assist in the prosecution of any claim for money or other damages which anyone may have, on account of injuries (including death), losses, or damages sustained by the Student, other parties in connection with his or her participation in the Program, and Executing Party waives any right he or she may have to do so. This means that Executing Party cannot sue to hold 21st Century Leaders responsible for any injury, loss, or damage sustained by the Student, other parties in connection with the Program, even if it is due to the negligence, act, omission, or other fault of 21st Century Leaders.
Executing Party expressly agrees that this release is intended to be as broad and inclusive as permitted by the laws of the State of Georgia, and that this release will be governed by and interpreted in accordance with the laws of the State of Georgia without giving effect to its conflict of laws rules. Executing Party agrees that in the event that any clause or provision of this release is held to be invalid by any court of competent jurisdiction, the invalidity of that clause or provision will not affect the remaining provisions of this release, which will continue to be enforceable. Executing Party agrees that the sole and exclusive jurisdiction and venue for litigation between Executing Party and 21st Century Leaders will be a state or federal court having jurisdiction in Georgia.
BY SIGNING, EXECUTING PARTY ACKNOWLEDGES THAT HE OR SHE HAS READ AND UNDERSTOOD ALL OF THE TERMS OF THE 21CL PROGRAM RELEASE AND THAT HE OR SHE IS VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE 21ST CENTURY LEADERS.
You and your parent/guardian must read this section carefully.
21st Century Leaders has an excellent reputation. Your conduct at every 21st Century Leaders function should make a positive contribution to extending that reputation. It is expected that students behave, use language, and dress in a manner that is consistent with the goals of developing and demonstrating professional-level leadership.
Consistent with this Code of Conduct, all participants will be expected to:
1. Behave in a non-threatening, courteous and respectful manner, refraining from language and actions that would discredit them, their school, other delegates, advisers, or 21st Century Leaders, whether in-person or online.
2. Obey all local, state, and federal laws, and all rules and regulations of the host site, college or university.
3. Refrain from the use and/or possession of alcoholic beverages, illegal drugs and weapons. Alcoholic beverages and narcotics or other controlled substances, and weapons are not permitted. Any student found in possession thereof or present where other individuals are in possession thereof will be required to leave the Program, in addition to any other consequences or measures deemed appropriate by 21st Century Leaders.
4. Refrain from the use of electronic devices during the Program. If devices are visible and/or being used during a session, first a warning will be issued. If the offense continues, the electronic device will be collected by a 21st Century Leaders staff member and returned to the owner at the end of that day's programing. If a participant refuses collection by a staff member, 21st Century Leaders will remove such an individual from the Program event and take any other measures necessary to maintain the integrity of the Program.
5. Keep advisers or 21st Century Leaders staff informed of activities and whereabouts at all times. Under no circumstances are students allowed off-campus unless accompanied by a member of the 21st Century Leaders staff. Visitors, unless approved in writing by 21st Century Leaders, are not permitted at any overnight Program or associated event. Accidents, injuries, and illnesses must be reported to the 21st Century Leaders staff immediately.
6. Observe the curfews as listed in the Program materials. Curfew is defined as being in your own assigned room by the designated hour.
7. Act as guests of the host site, corporation, college or university. 21st Century Leaders must obey the rules of these facilities. Remember there are other professionals, students, faculty, and staff on site who have rights to use and enjoyment of the facility. Trash must be placed in the proper receptacles and not left in dorm rooms or meeting room floors. Individuals causing damage to any property or furnishings will be responsible for repair or replacement. Theft or vandalism of any kind will not be tolerated and may be reported to facility officials or local police.
8. Refrain from associating or fraternizing with individuals not participating in the Program, including students of the host college or university.
Sexual Misconduct:
1. Sexual relations of any kind, including consensual sexual acts or contact or public displays of affection while participating in any 21st Century Leaders Program, are strictly prohibited.
2. Students may not have guests, i.e. individuals not residing in a designated room, as determined by 21st Century Leaders, on their floor or in their room at any time at any 21st Century Leaders Program.
3. Incidents of sexual harassment and/ or bullying, defined as comments and/or behavior of an implicitly or explicitly sexual, intimidating, or threatening nature or otherwise as determined by 21st Century Leaders, will not be tolerated, whether Student is participating in the Program in-person or virtually/online.
Disregarding or Violating this Code of Conduct:
Students who disregard or violate this Code of Conduct will be subject to disciplinary action, including, but not limited to, forfeiture of privileges to attend future 21st Century Leaders events or programs, and permanent dismissal from the Program(s). Parents and/or guardians will be notified, and 21st Century Leaders reserves the right to notify law enforcement, if applicable.
I have read this section carefully and acknowledge below to verify.
You and your parent/guardian must read this section carefully.
I, the parent/guardian, for myself and on behalf of the "Student" and our respective heirs, executors, administrators and assigns, hereby grant 21st Century Leaders and its officers, directors, employees and agents (collectively, the "21st Century Leaders”) the unconditional, worldwide, perpetual, royalty-free, assignable, sublicensable, irrevocable, and unrestricted right and license to (A) use photographs or videos that may contain the Student's image or likeness or stories, literature, or narratives submitted by, or relating to, the Student, interview and/or make both visual and/or audio recordings and still images of Student (collectively, the "Content"), (B) use Student's name, voice, likeness, biographical information, and any or all of the Content in any of 21st Century Leaders programming or the promotion thereof and (C) reproduce, modify, adapt, distribute, publish, display, exhibit, market, sell, and otherwise use in any media, by any means, methods and technologies now known or hereafter to become known, either in whole or in part, the Content for commercial purposes, including, but not limited to, promoting or publicizing the 21st Century Leaders (including the fundraising activities of the 21st Century Leaders) or otherwise furthering the mission of the 21st Century Leaders (the “Authorized Purpose”). In addition, the Student and I agree that the rights granted hereunder shall include the perpetual, worldwide right of 21st Century Leaders its parents, subsidiaries, and affiliated companies and their licensees, successors and assigns to edit, telecast, cablecast, rerun, record, publish, reproduce, use, syndicate, license, print, distribute and otherwise use in any media, by any means, methods and technologies now known or hereafter to become known, either in whole or in part, the Content for commercial purposes, including, but not limited to the Authorized Purpose. 21st Century Leaders shall be under no obligation to actually use Student's name, voice, likeness and biographical information or any of the Content.
On behalf of myself, the Student, and any other applicable parties, I hereby irrevocably waive and release (1) any claims or causes of action that may now exist or may arise in the future against 21st Century Leaders or any other party, for money or otherwise, in connection with the Authorized Purpose or any other activities and uses, including, without limitation, any and all claims for libel, defamation, infringement, or invasion of privacy or publicity, and any claims and demands arising by virtue of any blurring, distortion, alteration, optical illusion, digital enhancement or use in composite form or otherwise, and (2) any right to inspect or approve of the uses made by the 21st Century Leaders of the Content. I grant, assign, transfer, and convey to the 21st Century Leaders all copyrights and other intellectual property rights the Student or I own, if any, in or to the Content.
I have the full right and authority to grant the rights herein granted in connection with the Student with respect to all media, in perpetuity, throughout the world, and no other party's permission or consent is required. I realize that this consent cannot be withdrawn after I sign this Media Release and I acknowledge that the terms of this Media Release are binding on the Student, me, and our respective heirs, legal representatives and assigns, as applicable.
BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THE 21st Century Media Release AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS.
I have read this section carefully and acknowledge below to verify.
No amount is due, you can proceed with your submission.