Student EmPOWERment Summit- PRIDE Registration Form

Student EmPOWERment Summit- PRIDE 2025 Registration Form

Check out the summit website for updates and more information. All students regardless of race, ethnicity, sexuality, or gender are invited to attend the Summit. The Summit is on November 8, 2025, at Delaware Technical Community College in Georgetown, DE Doors open at 10am. Summit begins at 11am.
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*

VegetarianVeganNone
Race/Ethnicity*

Black/African AmericanWhiteHispanic or LatinoAmerican Indian or Alaska NativeMultiple RacesOtherI'd prefer not to say
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?*
I,   First Name   Last Name , give permission for my child,   First Name   Last Name  , to attend the 2025 Student EmPOWERment Summit- PRIDE and be transported to Delaware Technical Community College in Georgetown, DE by United Way of Delaware on November 8, 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
Identify your bus stop of choice

8:15am- Wilmington Penn Cinema- 401 S Madison St Wilmington DE8:30am- Christiana Mall Cinemark- 1200 Christiana Mall Newark DE9:00am- Westown Movies- 150 Commerce Drive Middletown, DE9:40am- Dover Mall (Dick’s Sporting Goods) – 1365 N DuPont Hwy, Dover, DE840am- Delmar Wawa- 38711 Sussex Highway Delmar, DE915am- Greenwood Royal Farms- 2 Schultz Rd, Greenwood DE930am- Milford Royal Farms – 566 Dupont Blvd, Milford, DE10am- Lewes Wawa - 17663 Darthmouth Dr Lewes, De
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
How likely are you are to recommend United Way of Delaware to a friend, colleague, or community member?

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0 is Worst, 10 is Best
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Student EmPOWERment Summit- PRIDE 2025 Registration Form

Transportation

Photo Release