Elevate Conference Student Registration

SECTION 1: Student Information

Name*

First Middle Last

Preferred Name / Nickname

Note: What the student likes to be called

Number*

Grade / School Year*

T-Shirt Size*

School Name*

City / State*

Student Phone Number

Career area student is curious about*

SECTION 2: Parent / Guardian Information

Parent/Guardian*

First Last

Relationship to Student*

Primary Phone Number

Drop-off Person (if different from parent)

Note: Full name of the person dropping the student off

Drop-off Person Phone

Authorized pick-up persons (besides the parent)*

Note: Comma-separated full names. Only listed individuals may pick up the student — valid ID required.

How did you hear about the Elevate Conference?*

School / Teacher

Friend or Family

Social Media (Instagram)

Social Media (Facebook)

LeadHER Newsletter

Community Organization

Other

SECTION 3: Medical & Accessibility

Does your student have food allergies or dietary restrictions?*

Yes

If Yes — Allergy / dietary details*

Does your student take any medications during the day?*

Yes

If Yes — Medication details*

Note: Name, dosage, timing etc Note: LeadHER and team will not administer medication.

Does your student require special accommodations?*

Yes

If Yes — Accommodation details*

Note: e.g., wheelchair access, sensory sensitivities

Is there anything else we should know about your student's health or well-being?

Note: General open-ended health notes

SECTION 4: Emergency Contact

Must be a person other than the parent/guardian completing this form.

Full Name*

First and Last Name

Relationship to Student*

Note: e.g., Grandmother, Aunt, Uncle

Phone Number*

Alternate Phone

SECTION 5 Student Code of Conduct — Consent

SECTION 6: Event Liability Waiver & Release — Consent

SECTION 7: Photo & Media Release — Consent

This field is for validation purposes and should be left unchanged.

LeadHER Elevate Conference