Influence for Good 2026 Youth Summit Registration

Influence for Good 2026 Youth Summit Registration

Influence For Good: Game Changers: Youth Leading the Way is a youth-focused conference designed to empower middle and high school youth with the knowledge, skills, and resources to make informed decisions about their physical, mental, and emotional well-being, ultimately promoting healthy behaviors and lifestyles. Please fill out this form individually for each youth participant you are registering.

Youth Registration

Please fill out this form individually for each youth participant you are registering.
Full Name of Youth Participant*

First NameLast Name
Age of Youth Participant (Youth must be age 11-18 to attend)*
Age (in years)
Date of Birth of Youth Participant*
(MM/DD/YYYY)
Full Name of Parent/Guardian*
Relationship to participant*
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
County of Residence*
YesNo
Does your child have any allergies, medical conditions, or special needs that the organizers should be aware of? If yes, please specify.*
YesNo

Parent/Guardian Registration

Please fill out this form for each adult participant you are registering.
Chaperone - I will stay with my youth during the programAdult Program - I would like to attend the adult session while my youth attendI would like to volunteer as an adult chaperone wherever I am needed.
Thank you for your interest in volunteering at Influence for Good 2026! You can complete our Volunteer Registration here!
Do you have any allergies, medical conditions, or special needs that the organizers should be aware of?*
I agree

Emergency Contact

In case of an emergency, please provide the name and contact number of an alternative emergency contact:
Emergency Contact Name*
Emergency Contact Phone Number*

Consent Form
I, undersigned, as the parent/legal guardian of the above-named participant, hereby grant permission for my child to attend Influence for Good 2026 Youth Summit. By registering for this event, I understand that as a participant, or as a parent or guardian of a participant, attending the Influence for Good Youth Summit, I may be exposed to discussions and content that touch on sensitive topics. These topics may include but are not limited to puberty, healthy relationships, and mental health. The intent of these discussions is to educate, raise awareness, and foster understanding among the youth participants, acknowledging that the depth and intensity of the content may vary.

By choosing to participate, or by permitting my child to participate, I am aware of these potential topics and commit to engaging with them in a respectful and constructive manner. I also recognize the value of open dialogue and fully support the summit's mission to empower youth to effect positive change in their communities.

Should you have any concerns or questions about the summit's content or discussions, please feel free to contact the event organizers for clarification or support.
I agree

Photo and Video Consent
I agree

Release of Liability
I agree
Should be Empty: