Conference Registration Form

🌟 First State Youth MOVE’s 3rd Annual Mental Health Summit 🌟

October 25th, 2025 @9:00am at Delaware State University!

Get ready for a day full of empowerment, connection, and real talk about mental health! 💬🧠✨

We’re bringing together youth, advocates, and community leaders to share stories, learn from each other, and support mental wellness across Delaware. Expect dope vibes, fun activities, and resources you can actually use. 💪🎉

📌 Important Info:

🚨 You must register individually — ONE person per form.

🙅‍♀️🙅 Please don’t register for multiple people in one submission.

✅ This helps us make sure everyone gets the best experience possible!

Come as you are and let's keep it real 💚 We can’t wait to see you there! #YouthMOVE

Full Name*

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Phone Number*

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Address*

Street Address

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Are you a: (Check all that apply)

Which topics are you most interested in? (Select all that apply)

If you selected other, please eleaborate

Dietary Restrictions/ Allergies

Will you need any accommodations to fully participate in this event?

Do you consent to be photographed/recorded during the event for promotional and documentation purposes?

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Parental Consent (for participants under 18):

Please provide parent name and contact information

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First State Youth MOVE's 3rd Annual Mental Health Summit Registration

Thank you for Registering!