Applicant Acceptance Form

Congratulations on being accepted into the 2023 Class! Please fill out the form below by November 11, 2022.

First Name        Last Name       
1. Please list your current email address; we will use email as our main source of communication.
Student Email         Parent Email    
2. Do you have any food allergies or special dietary restrictions. If so, please check all that apply:
If other, please explain:
3. Do you have any physical limitations that will require special accommodation at LB activities? Please specify in comments.
Leadership Buffalo, Inc. has my full permission to use photographs, slides, video, other media, etc., taken during any Leadership Buffalo function for publication/promotion by Leadership Buffalo.
I agree with the statement above

This release is being executed by me in connection with and in consideration of my participation in Leadership Buffalo. I am aware that Leadership Buffalo, Inc. is a not-for-profit corporation providing valuable local experiences to current and/or potential leaders in the Western New York area. I understand I may be asked to participate in a variety of activities in connection with Leadership Buffalo such as, but not limited to, tours of prisons, plants, construction sites, social agencies, and other public and private facilities. I also understand that in the course of any such activity, I could experience or incur personal injury or death or damage to my property. I voluntarily assume all risk of such injury, death and damage and hereby release Leadership Buffalo, Inc. from all claims which I may have or acquire related thereto.

I will comply with all instructions, rules and regulations of Leadership Buffalo while I am participating in any Leadership Buffalo program or event.

This agreement shall inure to the benefit of Leadership Buffalo, Inc. and shall be binding on myself, my heirs, executors, legal representatives, administrators and assigns.

I agree with the statement above
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