October 2025 BCYF Opening Plenary Application: Practitioner's Institute Form

October 2025 Learning Lab Opening Plenary: Practitioner's Institute

Destination: New York City, NY

Dates: Monday, October 27, 2025 - Thursday, October 30, 2025

Draft Itinerary

Monday, Oct 27, 2025: Arrival & Welcome

Tuesday & Wednesday, October 28-29, 2025: Harlem Children's Zone Practitioner's Institute Day 1 & 2

Thursday, Oct 30, 2025: Debrief and return home
BCYF Learning Lab Opening Plenary 2025 Application Form: Harlem Children's Zone Practitioner's Institute

Each organization can ONLY send ONE representative. Spaces are limited!
BCYF Opening Plenary Application Process --

Sponsored by the generosity of Harlem Children's Zone, BCYF has been invited to participate in their Practitioner's Institute.

Spaces for this opportunity are limited.

The application for the Harlem Children's Zone Practitioner's Institute will be available from September 25-October 1 at 12pm NOON.

On October 1, BCYF will compile all organizations that have had at least 1 person register. Each organization will be placed into a raffle and spaces will be filled with each organization drawn.

Organizations will be notified via email and have 24 hours (1 day) to confirm or decline. Please select the most appropriate email address for you to easily monitor.

There will be future opportunities to participate in the learning lab Opening Plenary.

Applicants MUST be 21 years of age or older by September 1, 2025 to participate in this opportunity, e.g. date of birth must be BEFORE September 1, 2004.

You will not be able to save your application and submit later, please compile all the information you need before completing the form.

Information You Need to Complete the Application:
- Dietary Requirements & Accessibility
  - Airborne or Food Allergies
- Travel Information
  - Emergency Contact
Contact Information
Your Name--This is how you would like to be listed for group activities, e.g. this will be used for name tags.*

PrefixFirst NameLast NameSuffix
Organization/Program Name*
Active in Baltimore City.A Youth-centered program.
Your Role at the Organization*
BCYF Current GranteeBCYF Board of DirectorsBCYF Staff
Your Email*
example@example.com
Input Your Email Address Again*
example@example.com
Cell/Mobile Phone Number--to receive SMS messages*
Please enter a valid phone number.Format: (000) 000-0000.
Opening Plenary Waitlist Preferences

Please let us know your preferences for this registration process.
Waitlist me!Do not waitlist me!
None. I do not have any dietary restrictions.VegetarianVeganHalalKosherGluten-FreeDairy-FreeAllergyOther
If Allergy or Other selected above, please share additional details here:
None. I do not need any modifications to participate.Wheelchair accessI will be accompanied by a service animalADA compliant hotel accommodationsOther
SMMLXL2X3X4X
Notes for organizers?
Travel Information

This section is required for BCYF to purchase a train ticket for you.
Legal Name

Please enter your name as it appears on your Driver's License or other acceptable identification for travel and hotel check-in: https://www.tsa.gov/travel/security-screening/identification
Legal Name*

First NameMiddle NameLast NameSuffix
Your Date of Birth*

MonthDayYear
Date of Birth
FemaleMaleNon-Binary
Emergency Contact Information

In the event of an emergency, who should BCYF call?
Emergency Contact Name*

First NameLast Name
Spouse/PartnerParentChildSiblingFriendCommunity Member
Emergency Contact Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Backup Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Liability Waiver
Signature

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Release and Consent to Use Likeness in Images and Recordings
For good and valuable consideration, the Undersigned,, irrevocably grants BCYF vendors (the “Photographer”), BCYF Archivist (the “Archivist”), and the Baltimore Children and Youth Fund (“BCYF”) my permission and the right to use any and all photographic or other images and audio or video recordings taken of me and including my likeness (referred to as "Images"). The Undersigned acknowledges and agrees that the Photographer and Archivist will submit the Images and recordings to BCYF to be used for marketing purposes by BCYF in print, digital, and online publications or media. The Undersigned irrevocably grants BCYF, including its affiliates and collaborating partners, permission to use, re-use, publish, re-publish, and prepare derivative work of the Images, for any purpose in furtherance of BCYF’s mission, in perpetuity throughout the world, and in any medium, format, or platform now existing or hereafter created without further consent from or any royalty, payment, or other compensation to the Undersigned. The Undersigned further acknowledges and agrees that BCYF has no obligation to use the Images and Recordings, and that the Undersigned has no right to review or approve the Images.**

Yes, I agree.
Signature

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Reimbursement

All attendees can submit reimbursement receipts for approved food and beverage they may require while traveling outside of provided meals. Please use this reimbursement if needed. To process your reimbursement, submit the BCYF Reimbursement Form with itemized receipts by November 14, 2025. Late submissions will NOT be accepted.
Yes, I agree.
Certifications & Signature

Please review and confirm the following statements regarding:
Opening Plenary Application & Waitlist Policy:
- I understand that I must be at least 21 years of age by September 1, 2025 in order to participate on this trip.
- I understand that submission of this form DOES NOT guarantee that there will be a space for me for 2025 Learning Lab Opening Plenary.
- I understand that if I do not complete this form completely, I understand that I must complete ALL requirements prior to being considered for a space for 2025 Learning Lab Opening Plenary.
- I understand that if Learning Lab Opening Plenary is completely sold out, I will be waitlisted ONLY if I indicated that I would like to be waitlisted. If I did not wish to be waitlisted, I will not be waitlisted.
Yes, I agree.
Opening Plenary Health, Safety, and Participation Policy:
- I understand that there will be considerable walking as a part of the Opening Plenary.
- I understand that the Opening Plenary will contain a full schedule of activities and I intend to participate fully.
- I agree to test for COVID-19 before the Opening Plenary in accordance with BCYF guidelines.
- I understand that if I test positive for COVID-19 or am experiencing cold/flu or other illness symptoms 3-5 days before the Opening Plenary departure flight, BCYF will require that I stay home to recover. I must notify BCYF of this as soon as I know.
- I understand that I am responsible for ensuring that my identification cards/documents meet the Transportation Security Administration requirements for travel.
- I understand that I am responsible for ensuring that I arrive on-time and I understand that BCYF will not wait for me to arrive.
- I understand that BCYF will make efforts to accommodate my stated dietary requirements, but BCYF cannot control the actions of individuals and businesses.
- I understand that it is my responsibility to bring any potentially necessary medication with me on this trip, e.g. over-the-counter or prescription medication, Epi-pen, etc.
- I understand that it is my responsibility to bring my health insurance information and provide such information to my emergency contact.
Yes, I agree.
Opening Plenary Information, Updates, & Reimbursement Policy:
- I understand that BCYF will contact me via email before, during, and after the Opening Plenary to communicate next steps, important updates and reminders. I agree to receive emails at the email address provided.
- I understand that if I made a mistake on the form or part of my travel information has changed, I MUST notify BCYF as soon as I am aware of that change.
- I understand that if my plans change, I MUST notify BCYF to offer my space to someone on the waitlist.
- I understand that if I participate, I am responsible for keeping receipts required and submitting appropriate documentation by the deadline for reimbursement.
Yes, I agree.
Signature

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BCYF Learning Lab Opening Plenary 2025 Application Form: Harlem Children's Zone Practitioner's Institute

Contact Information

Opening Plenary Waitlist Preferences

Travel Information

Legal Name

Emergency Contact Information

Liability Waiver

Release and Consent to Use Likeness in Images and Recordings

Reimbursement

Certifications & Signature