Cumbre de Empoderamiento Estudiantil 2025

2025 Cumbre de Empoderamiento Estudiantil Registration Form

Check out the Student EmPOWERment Summit- Latinos Unidos website www.uwde.org/LUSS for Summit updates and the workshops. All students regardless of race, ethnicity, sexuality, or gender are invited to attend the Summit. The Summit is on October 18, 2025 , at Poly Tech High School- 823 Walnut Shade Rd, Woodside, DE 19980, Doors open at 9am. Summit begins at 10am.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Zip Code*
Gender *
Role*
School*
School District*
Year in School*
T-shirt Size*
Dietary Restrictions*

VeganNone
What race best describes you?*

American Indian or Alaska NativeAsianBlack/African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther
What is your ethnicity?*

Hispanic or LatinoNot Hispanic or Latino
Transportation

Please complete the information below. If you are under 18 years of age, please have this signed by a parent or guardian.
Do you need bus transportation to the event?*
Identify your bus stop of choice

Hodgson Vocational Tech School- 2575 Glasgow Ave Newark, DEASPIRA High School- 750 Otts Chapel Road Newark, DEMilford High School- 1019 N Walnut St Milford, DELa Esperanza, Inc.- 216 N Race St Georgetown, DE
I,   First Name   Last Name , give permission for my child,   First Name   Last Name  , to attend the 2025 Cumbre de Empoderamiento de estudiantil- Latinos Unidos Summit and be transported to PolyTech High school in Dover, DE by United Way of Delaware on October 18, 2025.

I release and hold harmless United Way of Delaware, its employees, contractors, volunteers, and associates, past or future, fully and completely, from all liability and mishap or injury to the student named herein from the time of departure to the time of return.

I authorize the staff and/or volunteer to administer emergency medical assistance if I cannot be reached.
Emergency Contact First Name   Emergency Contact Last Name

Area Code   Phone Number

Signature
Photo Release

Please complete the information below. If you are under 18 years of age, please have this signed by a parent or guardian.
I,   First Name*   Last Name* hereby give to United Way of Delaware, it's partners, affiliates, contractors and volunteers, the absolute and irrevocable right and permission with respect to the photographs that he/she has taken of myself and/or my minor child in which he/she may be included with others:

a) To copyright the same in the photographs in United Way of Delaware, it's
partners, affiliates, contractors and volunteers or any other name that they
may select;

b) To use, re-use, publish and re-publish the same in whole or in part, separately
or in conjunction with other photographs, in any medium now or hereafter known,
and for any purpose whatsoever, including (but not by way of limitation)
illustration, promotion, advertising and trade, and;

I, hereby release and discharge United Way of Delaware, it's partners, affiliates,
contractors and volunteers from all and any claims and demands ensuing from or
in connection with the use of the photographs, including any and all claims for
libel and invasion of privacy.

United Way of Delaware, it's partners, affiliates, contractors and volunteers are not
responsible for any injuries inflicted upon any participating parties.
Client(s) will be responsible for their children and for themselves and release
photographer from any claims against their person or their business.

Signature, if over 18 years of age

Parent Signature if under 18 years of age
Should be Empty:

2025 Cumbre de Empoderamiento Estudiantil Registration Form

Transportation

Photo Release