MindBlast XR Hackathon School Participation Form
Empowering Students to Innovate, Create, and Solve Real-World Challenges Through Immersive Technology Experiences
EVENT DATE: April 14 - April 18, 2025 EVENT LOCATION: TBD SUBMISSION DEADLINE: February 24, 2025
School Information
Essential Details to Connect and Collaborate with Your School Team
School Name
*
School Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Who is filling out this form?
*
First Name
Last Name
Person's Title/Position
*
Person's Phone Number
*
Please enter a valid phone number.
Person's Email
*
example@example.com
Back
Next
Team Information
Build Your Team: Share Details About Your Student Participants and Focus Areas
Number of students participating (5 Max)
*
Grade Levels of Participants (Check all that apply):
*
Grades 5
Grades 6
Grades 7
Grades 8
Preferred Focus Area for Hackathon (Optional):
Social Justice
Environmental Challenges
Community Engagement
Other
If other, please specify
Back
Next
Technology Access
Ensuring Your Team Has the Tools and Resources for a Seamless Hackathon Experience
Does your school have access to the following (Check all that apply):
*
Laptops or Desktop Computers
High-Speed Internet
Virtual Reality Equipment
Other (Specify): _________________________
If other, please specify
*
Will your school require equipment to be loaned for the event?
*
Yes
No
Not for all students
Back
Next
Supervision and Support
Guidance and Leadership: Supporting Students Throughout the Hackathon Journey
Teacher/Chaperone Name(s): This will be the team's contact person.
*
First Name
Last Name
Contact Person's Phone Number
Please enter a valid phone number.
Contact Person's Email
*
example@example.com
Back
Next
Logistics
Planning the Details: Transportation, Accommodations, and Special Requirements
Does your team require transportation assistance to the event location?
*
Yes
No
Maybe
Do any of the student participants have any dietary restrictions or special accommodations?
*
Yes
No
If yes, please specify
*
Back
Next
Participation Fee:
A $500 participation fee is required for each school team to join the MindBlast XR Hackathon. Payment is due upon submission of this form and can be made via check or online payment.For any payment-related inquiries, please contact Juan Rodriguez at juan@wcxr.org.
Participation Confirmation:
Please confirm your school’s intent to participate in the MindBlast XR Hackathon and your understanding of the $500 participation fee requirement.
*
Yes, we understand the $500 participation fee is required, and we are excited to participate! We will submit payment via [Check / Online Payment Portal] along with this form.
No, we will not be participating in the MindBlast XR Hackathon this year.
Back
Next
Consent and Agreement
By signing below, you confirm your school’s participation in the MindBlast XR Hackathon and agree to ensure all necessary permissions (e.g., parental consent forms) are obtained for participating students.
School Administrator’s Name:
*
First Name
Last Name
Signature
*
Date
*
-
Month
-
Day
Year
Date
Back
Next
Submission Instructions
Please email the completed form to Juan Rodriguez at juan@wcxr.org by Monday, February 24, 2025. For any questions, contact us at 401-497-6988 or 401-328-2602.
Submit
Should be Empty: