2026 Power Her Forward Conference Registration Form

YOUTH ATTENDEE INFORMATION:
Attendee Full Name:*

First NameLast Name
My Email Address:*
example@example.com
My Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth:*

MonthDayYear
Date
Middle/High School/ Program:*
Yes, I’m interested! Please send me more details.Maybe! I’d like to learn more.No, not at this time.
PLEASE READ: This event is for teens only! However, an approved support person may attend with a participant due to medical or other developmental/special needs.
PLEASE CHOOSE YOUR TOP THREE (3) WORKSHOPS THAT YOUR PARTICIPANT IS MOST INTERESTED IN.

We will try our best to place them in the workshops they choose. While we cannot guarantee all three, we will do everything we can to match their top choices.
Build Your Brand: Show Up and Stand Out OnlineGreen Flags Only: Mental Health and Healthy RelationshipsHow I Learn Best: Unlocking My Brain PowerBoss Moves: How to Start Your Own BusinessGet to the Bag: Money, Saving, and Smart SpendingCreate Your Vibe: Express Yourself Through ArtWhat’s Really Happening to Your Brain? The Truth About Substance Use
EMERGENCY CONTACT INFORMATION:
Person 1: Emergency Contact Name:*

First NameLast Name
Person 2: Emergency Contact Name:

First NameLast Name
Person 1: Emergency Contact Phone:*
Please enter a valid phone number.Format: (000) 000-0000.
Person 2: Emergency Contact Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Person 1:Relationship to Participant*
Person 2: Relationship to Participant
Email Address: *
DIETARY PREFERENCES/RESTRICTIONS:
VeganGluten FreeDairy FreeNut AllergyPeanut AllergyNo PorkHalalNo Restrictions
SPECIAL ACCOMMODATIONS:
My child will be attending the event with an approved support person due to medical or developmental/special needs.ASL InterpreterWheelchair AccessibilityQuiet RoomClosed CaptioningBabysitter for the Attendees ChildSpecial Needs Chaperone (Non-Medical)Bus Pass (Passes will be mailed to the address on file)ParaTransit AssistanceNo Accommodations NeededOther (Please fill in the section below)
THINGS WE SHOULD KNOW ABOUT YOUR CHILD:
Is there anything important you would like us to know to help us best support your attendee? We want to ensure they feel safe, supported, and included during the conference.Examples may include medical needs, learning accommodations, or childcare needs.
MEDIA RELEASE:
Yes, I give permissionNo, I do not give permission
LIABILITY RELEASE:
ACCEPTANCE REQUIRED: By registering my child to participate in the Girls Conference hosted by the Women’s Foundation of Genesee Valley, I acknowledge that participation in this event is voluntary and may involve activities that carry inherent risks. These risks may include, but are not limited to, personal injury, illness, emotional distress, property loss, or other unforeseen circumstances.I hereby grant permission for my child to participate fully in all conference activities. I understand and accept full responsibility for any risks associated with my child’s participation, whether such risks are known or unknown.To the fullest extent permitted by law, I agree to release, waive, and hold harmless the Women’s Foundation of Genesee Valley, along with its officers, directors, employees, volunteers, partners, sponsors, and affiliates, from any and all claims, liabilities, demands, damages, or causes of action of any kind, including those resulting from injury, illness, death, or loss of property, that may arise from my child’s participation in this event.I understand that the Women’s Foundation of Genesee Valley cannot provide continuous one on one supervision and is not responsible for participants who choose to leave the designated conference area without authorization. I accept responsibility for my child’s conduct and actions, including adherence to conference rules and expectations.I further understand that this release applies to any claims based on negligence to the fullest extent allowed by law. I agree not to initiate or permit any legal action on behalf of my child against the Women’s Foundation of Genesee Valley related to participation in this event.I certify that I am the parent or legal guardian of the participant and that I have the authority to provide this consent and release. By submitting this form, I acknowledge that I have read, understand, and voluntarily agree to the terms outlined above.*

I have read, understand, and agree to the Parent or Guardian Consent, Assumption of Risk, and Liability Release.I am 18+ and I have read, understand, and agree to the Assumption of Risk, and Liability Release.
BEHAVIOR AND SAFETY EXPECTATIONS:
This event is secured and designed with the safety of all participants in mind. Please take a moment to review the safety guidelines available on the conference main page.

If your child requires emergency medication, such as an asthma inhaler, EpiPen, or seizure medication, or any other life saving medication, please ensure they attend the conference with their medication clearly labeled, up to date, and accompanied by written instructions for use. They must trun in any controlled substances to our medical team to keep it secured during the event. In the event of a medical emergency, a parent or guardian will be contacted to obtain verbal consent for treatment.

Thank you for helping us keep everyone safe.
Should be Empty:

YOUTH ATTENDEE INFORMATION:

PLEASE READ: This event is for teens only! However, an approved support person may attend with a participant due to medical or other developmental/special needs.

PLEASE CHOOSE YOUR TOP THREE (3) WORKSHOPS THAT YOUR PARTICIPANT IS MOST INTERESTED IN.

EMERGENCY CONTACT INFORMATION:

DIETARY PREFERENCES/RESTRICTIONS:

SPECIAL ACCOMMODATIONS:

THINGS WE SHOULD KNOW ABOUT YOUR CHILD:

MEDIA RELEASE:

LIABILITY RELEASE:

BEHAVIOR AND SAFETY EXPECTATIONS: