Teacher Leadership Training Session Form

Teacher Leadership Training Session Form

Participant Information

Date of Birth:    Teacher License / Certification #:

Email:    Phone:

Session Details

Session Date:    Time:

Delivery Format: In-person Virtual Hybrid

Professional Background

Years of Teaching Experience:    Current Grade Level(s):

Prior Leadership Roles (check all that apply): Grade-level leader Department head Instructional coach Other

Learning Goals & Session Objectives

Accommodations, Medical & Emergency Contact

Do you require accommodations to fully participate? Yes No

Relationship:    Phone:

Fees, Payment & Attendance Policy

Tuition / Fee (if applicable): $

Attendance Requirement: Participants must attend a minimum of 80% of the scheduled contact hours to receive a certificate of completion. Missed hours must be made up by prior arrangement with program staff. Failure to meet attendance requirements relieves the sponsor of any obligation to issue credit or certificates.

Cancellation and Refund: Requests to cancel registration must be submitted in writing to program administration at least 14 days prior to the session start date. Refunds, if authorized, may be subject to an administrative processing fee withheld from the refunded amount. The program reserves the right to cancel or reschedule sessions; in such cases registered participants will be offered alternate dates or full refund.

I acknowledge and accept the attendance and cancellation policy: Yes, I accept

Consent, Confidentiality & Liability

Certification: I certify that the information provided on this form is true and complete to the best of my knowledge. I understand that false statements may result in denial of participation or revocation of any certificate issued.

Confidentiality: Participants will have access to materials and discussions that may include student or staff information. Participants agree to safeguard confidential information in accordance with applicable law and district policy and will not disclose identifiable student information without required authorization.

Intellectual Property: Course materials remain the property of the provider unless otherwise stated. Participants may use materials for classroom and professional practice but shall not reproduce or distribute materials for commercial purposes without written permission.

Liability: To the extent permitted by law, the program and its affiliates are not liable for loss, damage or injury to person or property arising from participation in the session. Participants agree to indemnify and hold harmless program organizers from claims arising from participant conduct.

Photo / Video Release: I grant permission for non-identifiable photographs and recordings to be used for program documentation and professional development purposes. I decline permission

Data & Evaluation: I consent to use of my participation data for program evaluation (aggregate reporting only).

Administrator / Supervisor Notification

Final Acknowledgment

By signing below, I certify that I have read and understand the program requirements, attendance policy, confidentiality obligations, and liability provisions contained in this form. I commit to participating professionally and to complete any required follow-up assignments to receive program credit.

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