Student Cell Phone Number:
Select Your State
District Of Columbia
Black or African American
Hawaiian or Pacific Islander
White or Caucasian
Other (please specify)
I prefer not to respond
How did you hear about Ignite?
Friend or Family member
UT staff or student
School Guidance Counselor
Do you currently have health insurance?
Are you in the UT Lead program?
Which best describes your gender identity?
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone Number
Do you need any special accommodations from the Office of Disability Services or medical
conditions that we should be aware of?
Please enter N/A if this does not apply
Do you have any dietary restrictions?
Please enter N/A if you do not have
Please select which Ignite session(s) you would like to attend:
Ignite Leadership Summit Session 1
07/19/2019 - 07/21/2019
Ignite Leadership Summit Session 2
08/16/2019 - 08/18/2019
07/10/2019 - 07/14/2019
08/12/2019 - 08/15/2019
Ignite Outdoors A - Wilderness Backpacking
06/07/2019 - 06/10/2019
Ignite Outdoors B - Explore Hiking
06/12/2019 - 06/15/2019
Ignite Outdoors C - Wilderness Backpacking
06/14/2019 - 06/17/2019
Ignite Outdoors D - Explore Hiking
06/19/2019 - 06/22/2019
Ignite Outdoors E - Wilderness Backpacking
06/21/2019 - 06/24/2019
Ignite Outdoors F - Explore Rock Climbing
06/26/2019 - 06/29/2019
Ignite Outdoors G - Wilderness Backpacking
06/28/2019 - 07/01/2019
Ignite Outdoors H - Explore Hiking
07/10/2019 - 07/13/2019
Ignite Outdoors I - Wilderness Backpacking
07/12/2019 - 07/15/2019
Ignite Outdoors J - Explore Rock Climbing
07/17/2019 - 07/20/2019
Ignite Outdoors K - Wilderness Backpacking
07/19/2019 - 07/22/2019
Ignite Outdoors L - Explore Hiking
07/24/2019 - 07/27/2019
Ignite Outdoors M - Wilderness Canoeing
07/26/2019 - 07/29/2019
Ignite Outdoors N - Explore Hiking
07/31/2019 - 08/03/2019
Ignite Outdoors O - Wilderness Canoeing
08/02/2019 - 08/05/2019
Additional Housing Dates
Additional housing is optional the night before or after all June and July Ignite sessions.
This must be requested at least 10 days prior to the Ignite session(s) you are attending.
If you specify that you need additional housing we will contact you separately with
information regarding residence hall and check-in/check-out information. Additional housing
will be charged to your myUTK student account. Will you need housing before or after your
Ignite session? (Rooms are available on-campus for $28.15 per
person/per night. This fee is not included in the Ignite registration fee and will be
billed directly to the student's UTK account.)
6/06/2019 (prior to Ignite Outdoors A) 6/10/2019 (post Ignite Outdoors A) 6/11/2019 (prior to Ignite Outdoors B) 6/15/2019 (post Ignite Outdoors B) 6/13/2019 (prior to Ignite Outdoors C) 6/17/2019 (post Ignite Outdoors C) 6/18/2019 (prior to Ignite Outdoors D) 6/22/2019 (post Ignite Outdoors D) 6/20/2019 (prior to Ignite Outdoors E) 6/24/2019 (post Ignite Outdoors E) 6/25/2019 (prior to Ignite Outdoors F) 6/29/2019 (post Ignite Outdoors F) 6/27/2019 (prior to Ignite Outdoors G) 7/1/2019 (post Ignite Outdoors G) 7/09/2019 (prior to Ignite Knox) 7/13/2019 (post Ignite Knox) 7/11/2019 (prior to Ignite Outdoors I) 7/15/2019 (post Ignite Outdoors I) 7/16/2019 (prior to Ignite Outdoors J) 7/20/2019 (post Ignite Outdoors J) 7/18/2019 (prior to July Ignite Leadership Summit & Ignite Outdoors K) 7/21/2019 (post Ignite Leadership Summit) 7/22/2019 (post Ignite Outdoors K) 7/23/2019 (prior to Ignite Outdoors L) 7/25/2019 (prior to Ignite Outdoors M) 7/27/2019 (post Ignite Outdoors L) 7/29/2019 (post Ignite Outdoors M) 7/30/2019 (prior to Ignite Outdoors N) 8/03/2019 (post Ignite Outdoors N) 8/01/2019 (prior to Ignite Outdoors O) 8/05/2019 (post Ignite Outdoors O)
Do you need additional housing other than the dates specified above? Please contact
Completion of this registration form ensures that I will attend the Ignite
indicated in this registration form. I understand that the Ignite fee will be directly
billed to my UTK student account.
If you wish to switch your Ignite session you must send an email to firstname.lastname@example.org with the following information:
If you wish to cancel your Ignite registration you must send an email to email@example.com with the following information:
UTK student ID number
Ignite session you are currently registered for
Ignite session you wish to switch to
If space is available in the desired session the switch will be made for a $25 processing fee. The $25 processing fee will be placed on the student’s MyUTK account. The deadline for session switches is June 1.
Due to the nature of the Ignite program and the necessity for early planning and purchasing of supplies, no refunds are able to be given. If you have a medical or family emergency and wish to cancel your Ignite session, documentation will need to be submitted to firstname.lastname@example.org in order for a refund to be considered.
All session switches must be requested by 06/01/2019 , and will result in a $25 processing fee. Session switches will not be available after 06/01/2019 . Due to program
planning and the need to purchase supplies in advance we are unable to offer refunds.
UTK student ID number
Ignite session you are currently registered for
By initialing below, I verify that I have carefully read and understand the above and agree
to be bound thereby.
The University of Tennessee does not discriminate on the basis of race, sex, color,
religion, national origin, age, handicap, or veteran status in provision of educational
or benefits. The University of Tennessee does not discriminate on the basis of sex or handicap
educational programs and activities which it operates, pursuant to the requirements of Title IX
Educational Amendments of 1972. Public Law 92-318; and Section 504 of the Rehabilitation Act of
Public Law 93-112, and the Americans with Disabilities Act of 1990, Public Law 101-336,
This policy extends to both employment by and admission to the University. Inquiries concerning
Title IX and Section 504 and the the Americans With Disabilities Act of 1990 should be directed
Office of Affirmative Action, 2110 Terrace Avenue, The University of Tennessee, Knoxville,
or call (865) 974-2498. Charges of violations of the above policy should also be directed to the
Ignite 2019 Waiver and Release
The undersigned hereby acknowledges that he/she understands that participation in an
Ignite 2019 session, is purely voluntary and is not part of the academic curriculum of the
In consideration of the University making any equipment and/or facilities available to the
participants and/or the undersigned while participating in any such activities, the undersigned
the University of Tennessee, their successors, assigns, Trustees, officers, agents and employees
and all claims, demands, and causes of action whatsoever, in any way growing out of or resulting
undersigned student's participation in the activities of the organization. The undersigned
further agrees that
he/she understands that some of the activities of the Ignite sessions involve substantial risk
injury, property damage, and other dangers associated with participation in activites. It is
by the undersigned that he or she is solely responsible for any costs arising out of any bodily
injury or property
damage sustained through participation in normal or unusual activities at the Ignite sessions.
(The undersigned is
encouraged to obtain adequate hospitalization or property damage insurance coverage.) If the
undersigned is married
and/or a minor then the signature of the spouse, parent or guardian appearing in the space
indicated below signifies
acceptance by said spouse, parent or guardian that the terms and conditions hereof shall be
binding upon them and
shall constitute a release by them of any and all claims, demands. and causes of action
whatsoever which they or any
of them may have against the University of Tennessee, its successors, assigns, Trustees,
officers, agents or employees
as a result of the undersigned student's participation in the activities described. PLEASE READ
THE ENTIRE DOCUMENT
CAREFULLY BEFORE INITIALING. THIS RELEASES THE UNIVERSITY FROM ANY LIABILITY RESULTING FROM MY
PARTICIPATION IN THE
By initialing below, I verify that I have carefully read and understand completely the above
provisions and agree to
be bound thereby.
POLICIES AND PROCEDURES
I. Ignite is an alcohol-free and substance-free program sponsored by the Center for Leadership and Service at The University of Tennessee, Knoxville. Any prohibited substances or materials will be confiscated and disposed of if found during the program, and parent/guardian will be notified. After 10:00pm, Ignite participants are not allowed in establishments or residences where alcohol is being served or consumed. If found with prohibited substances or materials or in an establishment/residence that serves alcohol after designated hours, the participant will be subject to dismissal from the program at his/her own expense (see section VII). Prohibited substances include (but are not limited to): alcoholic beverages or containers, controlled substances (“controlled substances” as defined in the Controlled Substances Act, 21 U.S.C. 812), drugs, un-prescribed medication, or any drug paraphernalia.
II. Participants in the Ignite program must be present for the entirety of the Ignite program and must attend all components of Ignite programming including, but not limited to, service sites, and leadership programming between check-in and closing. Participants who do not participate in all components of the Ignite program will be subject to dismissal from the program at his/her own expense (see section VII).
III. Participants in the Ignite program may not participate in any pre-recruitment events for any University of Tennessee student organization for the duration of Ignite programming (between check-in and closing). Students found violating this policy will be subject to dismissal from the program at his/her own expense (see section VII) and student organizations could be subject to a recruitment violation through the Dean of Students office and/or the Office of Sorority and Fraternity Life. Student organizations will be alerted of this policy violation by the Center for Leadership and Service and/or Student Conduct & Community Standards. Women who have registered for Panhellenic Recruitment may participant in recruitment orientation during the designated hours given by the Office of Fraternity and Sorority Life and then must return to Ignite programming immediately following.
IV. Participants in the Ignite program are asked to report any dietary restrictions and/or medical conditions to the Center for Leadership and Service staff to best serve their needs. Participants should also register with the Office of Disability Services (http://ods.utk.edu//) for circumstances which will require specific accommodations. Please let the Center for Leadership and Service know if you need any special accommodations throughout any part of the Ignite program.
V. Participants in the Ignite program are held to the standards of The University of Tennessee Hilltopics (Student Handbook) which can be found at http://dos.utk.edu/hilltopics/. Any violation of the University of Tennessee Hilltopics and/or the Ignite Serves program policies may result in judicial action and dismissal from the program (see section VII). Parent/Guardian will be notified of any violation of The University of Tennessee Hilltopics (Student Handbook)
VI. Ignite is a safe and welcoming environment that promotes civility towards all individuals. All participants are expected to demonstrate respect to each other, staff, faculty, and student leaders at all times. Participants who engage in conduct that causes or provokes a disturbance (during any Ignite programming on or off campus) that disrupts the academic pursuits, or infringes upon the rights, privacy, or privileges of another person may be subject to dismissal from the Ignite Serves program and/or may face disciplinary charges in the Office of Student Conduct & Community Standards.
VII. If an Ignite participant’s violation of the Ignite policies and procedures results in their dismissal from an Ignite program occurring on campus, the student will not be allowed to return to their residence hall or any other Ignite programming. The dismissal will occur at the student’s expense, and he/she will be asked to immediately relocate from campus and will not be allowed to return to campus until official move-in day at his/her own expense. Parent/guardian and the Office of Student Conduct & Community Standards will be notified of the dismissal from the program.
VIII. If an Ignite participant is injured and requires medical assistance during the Ignite program, the participant will be responsible for paying all medical and transport expenses related to their medical care. Participants will fill out the “Release Form” and turn in a copy of their health insurance card; if a student does not have health insurance, he/she will need to fill out the “Health Insurance Waiver.” The participant will need to contact a Center for Leadership and Service administrator at the time of the injury and sign an Injury or Incident Report Form documenting the injury.
IX. Ignite fees generally include lodging, transportation to and from site(s), supplies, materials and some meals. The Ignite program may require additional spending money to cover including, but not limited to, souvenirs, snacks, etc. Additional food expenses will be incurred by participants at the Ignite Serves program and may be incurred at Ignite Knox. For meals not provided during Ignite Serves, participants will be able to use their meal plan’s Dining Dollars at open Aramark locations throughout campus during a majority of meal times until meal plans officially begin on move-in day.
X. Participants are required to utilize University of Tennessee-provided transportation to and from program site(s). Exceptions to this are rare and must be discussed and approved in writing 5 days prior to trip departure. University of Tennessee administrators have sole and final discretion regarding transportation arrangements.
XI. Participants will not be allowed to visit the homes/residences of current University of Tennessee students including fraternity and sorority housing. Exceptions to this are rare and must be discussed and approved in writing by August 1, 2019. Additionally, participants staying in on-campus housing must adhere to University Housing’s visitation policies. University of Tennessee administrators have sole and final discretion regarding housing and visiting arrangements.
XII. University of Tennessee administrators have final decision-making authority regarding all Ignite matters.
By initialing below, I agree that I have read and agree to the policies and procedures of
Ignite. I understand that failure
to abide by these policies and procedures will result in judicial action with the Office of
& Community Standards and may result in my dismissal from the Ignite Serves program at my