MindBlast XR 2026 | Official Student Registration

1

How are you registering?* This field is required.

School or Organization (complete sections 2A and 2B)

Team (3–5 students- complete section 2B)

Individual Student (complete section 3)

2

School or Organization Name* This field is required.

3

Primary Contact Name* This field is required.

First Name

Last Name

4

Contact Email* This field is required.

example@example.com

5

Contact Phone Number* This field is required.

Please enter a valid phone number.

6

How many students are you registering?* This field is required.

7

Team Name* This field is required.

8

Team Contact Name (Adult or Coach)* This field is required.

First Name

Last Name

9

Team Contact Email * This field is required.

All hackathon information will be sent to this email

10

Team Contact Phone Number* This field is required.

This is the phone number that will be contacted during the week of the hackathon

11

Team Captain Full Name (student)* This field is required.

First Name

Last Name

12

Team Captain's School Name* This field is required.

13

Teammate 1* This field is required.

First Name

Last Name

14

Teammate 1's School Name* This field is required.

15

Teammate 1's Grade* This field is required.

5th Grade

6th Grade

7th Grade

8th Grade

16

Teammate 2* This field is required.

First Name

Last Name

17

Teammate 2's School Name* This field is required.

18

Teammate 2's Grade* This field is required.

5th Grade

6th Grade

7th Grade

8th Grade

19

Teammate 3

First Name

Last Name

20

Teammate 3's School Name

21

Teammate 3's Grade

5th Grade

6th Grade

7th Grade

8th Grade

22

Teammate 4

First Name

Last Name

23

Teammate 4's School Name

24

Teammate 4's Grade

5th Grade

6th Grade

7th Grade

8th Grade

25

Student First Name* This field is required.

First Name

Last Name

26

Current Grade Level* This field is required.

5th Grade

6th Grade

7th Grade

8th Grade

27

School Name* This field is required.

28

City / Town* This field is required.

29

Student's Email (not a school email-Please use a personal email address if available.)* This field is required.

example@example.com

30

Parent / Guardian Full Name* This field is required.

First Name

Last Name

31

Parent / Guardian Email* This field is required.

example@example.com

32

Parent / Guardian Phone Number* This field is required.

Please enter a valid phone number.

33

Relationship to Student* This field is required.

Parent

Guardian

Other

Type option 4

34

Has the student participated in MindBlast XR in the past?* This field is required.

Yes

No

35

Can the student attend all five days (April 20–24, 2026)? If “No” is selected, display message: Full attendance is required to participate in MindBlast XR.* This field is required.

Yes

No

37

What is the student most excited to work on? (Select all that apply)* This field is required.

Virtual Reality (VR)

Augmented Reality (AR)

Artificial Design (AI)

Game Design

Coding

Design Thinking

Team Projects

Presenting Ideads

38

How much experience does the student have with technology or coding? (Beginners are encouraged to apply.)* This field is required.

No experience

A little experience

Some experience

A lot of experience

39

Photo and Video Release- Permission for my child to be photographed or recorded during MindBlast XR 2026 for educational, promotional, and reporting purposes by Winners’ Circle XR Academy, Inc.* This field is required.

I Agree

I Disagree

40

Code of Conduct Agreement- MindBlast XR is a collaborative and respectful learning environment and agree that my child will follow the program’s code of conduct.* This field is required.

I understand and agree

I do not understand and disagree

41

Participation Confirmation- The information provided is accurate and that my child is able to fully participate in MindBlast XR 2026.”* This field is required.

I confirm

I do not confirm

42

Anything else you’d like us to know?

43

Would you like to receive updates and reminders about MindBlast XR 2026?* This field is required.

Yes, please send me and my child updated information

No, please just share the information with my child