WRHLI High School Leadership Summit

28th Annual William R. Harvey Leadership Institute High School Leadership Summit

Registration & Payment Form - July 7-12, 2025
The 28th Annual High School Leadership Summit is designed for rising high school Juniors or Seniors to focus on “The Leader Within.” This week long RESIDENTIAL program provides students the opportunity to establish a plan for after graduation through several exciting and challenging workshops.

Date: Monday, July 7, 2025 – Saturday, July 12, 2025
Location: McGrew Conference Center
Theme: STEAM Leaders: Exploring the Next Frontier

Parent/Guardian Information
Parent/Guardian Name*
Is the Parent/Guardian address the same as participant's/student's?

YesNo
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent or Guardian Email*
example@example.com
Parent or Guardian Phone Number*

Medical Clearance Requirements
Medical Clearance forms are required to be submitted for each residential attendee prior to June 6, 2025. The medical forms can be mailed or emailed to the William R. Harvey Leadership Institute. All students must be medically cleared by the Hampton University Health Center prior to attending the Leadership Summit.

Download the Hampton U. Summer Programs Medical Clearance Form (opens in a new window/tab)

Email: leadershipinstitute@hamptonu.edu

Postal Address:
William R. Harvey Leadership Institute
ATTN: High School Leadership Summit
P.O. Box 6143
Hampton, VA 23668

Photography Release Consent
During the Leadership Summit, we would like to capture photos and videos of the students in action. Since our attendees are minors, we require photography release consent from parents/guardians. We will not post any photos and/or videos of your child on our personal webpages. Any photos and/or videos released by faculty or staff of the university will be on official Hampton University websites and webpages only.
By selecting YES, below, you hereby authorize the University and those acting pursuant to its authority to:
- Record your child’s likeness and voice in any medium and use your child’s name in connection with these recordings;
- Use, reproduce, exhibit or distribute in any medium these recordings for any purpose that the University deems appropriate, including promotional or advertising efforts.
- You release the University from liability for any violation of any personal or proprietary right you or your child may have in connection with such use.
- You understand all such recordings, in whatever medium, shall remain the property of the University.
- You have read and fully understand the terms of this release.
Do you authorize Hampton University to use photos and/or video footage of your child?*

YES, I authorize the use of photos and/or videos of my child.NO, I do not authorize the use of photos and/or videos of my child.

Payment Details

Please provide your payment details below.
Residential Registration Fees:
- Regular Registration Fee: $1,100.00 – Until May 30, 2025
  Must be paid in full (credit card) and/or postmarked (cashier check/money order) by May 30, 2025, 12:00 pm.
- LATE Registration Fee: $1,500.00 – May 31 - June 6, 2025
  Must be paid in full by June 6, 2025 (credit card payment only) 12:00 p.m.
How would you like to pay?*

Credit/Debit Card (Online Payment)Money OrderCashier's Check
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Date
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Hour Minutes
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Online Payment*

USD

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Money Orders and Cashier's Checks

Payments in the form of Money Orders/Cashier's Checks (no personal checks accepted) should be made payable to:

William R. Harvey Leadership Institute, Hampton University

Payment Due: {paymentDue}

Review

Review your information before you complete registration.
Participant Information

Name: {participantName}

Parent Information

Parent/Guardian Name: {parentguardianName}
Email: {parentOr102}
Phone: {parentOr100}

Payment Details

Payment Method: {howWould}
Amount Due: {paymentDue}
Participant Information

Name: {participantName}
Gender: {gender}
Address: {participantsAddress}
Phone: {participantPhone}
High School Name: {highSchool}
High School Address: {highSchool91}
Grade: {studentGrade}
Intended College Major: {intendedCollege}
Shirt Size: {shirtSize}
Dietary Restrictions: {dietaryRestrictions}
Allergies: {allergies}

Parent Information

Parent/Guardian Name: {parentguardianName}
Address: {parentguardianAddress}
Email: {parentOr102}
Phone: {parentOr100}
Medical Clearance Terms Accepted: {typeA141}
Photo Release Authorization: {doYou}

Payment Details

Payment Method: {howWould}
Amount Due: {paymentDue}
Money Orders/Cashier's Checks

Payments in the form of Money Orders/Cashier's Checks (no personal checks accepted) should be made payable to:

William R. Harvey Leadership Institute, Hampton University
Reminders
- Regular Registration Fee: $1,100.00 – Until May 30, 2025
  Must be paid in full (credit card) and or postmarked (cashier check/money order) by May 31, 2024, 12:00 p.m.
- LATE Registration Fee: $1,500.00 – May 31 – June 6, 2025
  Must be paid in full by June 6, 2025 (credit card payment only) 12:00 p.m.
- Medical Clearance forms are required to be submitted for each residential attendee prior to June 6, 2025. The medical forms can be mailed or emailed to the William R. Harvey Leadership Institute. All students must be medically cleared by the Hampton University Health Center prior to attending the Leadership Summit.
- Postal Address for medical forms and money orders/cashier's checks:
  William R. Harvey Leadership Institute
  ATTN: High School Leadership Summit
  P.O. Box 6143
  Hampton, VA 23668
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28th Annual William R. Harvey Leadership Institute High School Leadership Summit

Participant Information

Parent/Guardian Information

Medical Clearance Requirements

Photography Release Consent

Payment Details

Money Orders and Cashier's Checks

Review

Participant Information

Parent Information

Reminders