Clone of 2026 Youth Media Day Registration

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Full Name* This field is required.
First Name
Last Name
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Nickname or Preferred First Name (optional)As you want it to appear on your name badge
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You're welcome to share your pronouns here or skip this optional question.Pronouns will appear on your name badge
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Email Address* This field is required.
example@example.com
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Phone Number* This field is required.
Area Code
Phone Number
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PIC NumberIf you would like to receive SCECHs
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Grade Levels You Teach* This field is required.Select all that apply
Kindergarten-2nd
6th-8th
3rd-5th
9th-12th
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Where do you teach?* This field is required.School Name & District
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What subject(s) do you teach?* This field is required.
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How many years have you been teaching?* This field is required.
Less than 3 years
5-10 years
3-5 years
More than 10 years
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What are you hoping to gain from attending this workshop?* This field is required.
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How did you hear about this EduCreate Workshop?* This field is required.If you click "other" please specify which organization you heard it from.
Social Media
Colleague or School
Flyer
Word of Mouth
Other
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Dietary Requirements* This field is required.
None
Nut Allergy
Gluten Free
Dairy Free
Vegetarian
Other
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"Other" Dietary Requirements If you selected "other", please tell us more - we will do our best to accommodate.
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Do you require any accommodations? * This field is required.Visual, hearing, mobility or other? If yes, please specify and we will do our best to accommodate.
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2026 EduCreate Workshop InformationInformation for Participants
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A Note to Participants from Organizers

We are looking forward to a fun and engaging day of hands-on learning with you!

WMCAT is located at 614 First Street NW, Suite 300, Grand Rapids 49504

Information, including detailed directions and reminders, will be sent to your you via email during the week of October 5.

free parking information and directions from parking to WMCAT

final details you'll need to know leading up to the workshop

the day's schedule

session details

what to bring

Have questions? We’re happy to help!

Kristyn Bomberg, Educational Services Manager, WGVU Public Media

bombergk@gvsu.edu or 616.331.6793
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Emergency Contact* This field is required.
First Name
Last Name
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Emergency Contact Phone Number* This field is required.
Area Code
Phone Number
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Is there anything we need to be aware of?* This field is required.Medical conditions, severe allergies, medications, etc. and steps to be taken to accommodate.
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MEDIA RELEASE AGREEMENT with WGVU Public Media, WGVU-TV, WGVK-TV, WGVU-FM, WGVS-AM/FM, WGVU.ORG, WGVUNEWS.ORG; Mosaic Film Experience, West Michigan Center for Arts + Technology (WMCAT), GVSU Journalism Broadcast and Digital Media, GVSU College of Education and Community Innovation, GVSU Charter Schools Office, The Steelcase Foundation, GVSU Division of K-12 Innovation and Scholar Success, GVSU GV NextEd Co-Lab, and Grand Valley State University.

In consideration of my participation in EduCreate Workshops: I hereby authorize you to photograph and record me and/or my likenss, on digital media, audio/videotape, print or otherwise. In relation to the services mentioned above, I authorize above mentioned partner organizations to use these for lawful purpose and as part of the publicizing and promotion of EduCreate Worshops and related educator programming for broadcast, educational, business, streaming, social media and distribution services (known and unknown). Additionally, I agree to the above conditions for use without monetary or any other form of compensation, now and in the future. I waive any rights of action I may have and release the above named organizations from any and all claims I may have arising from my likeness, including any rights to sue for defamation or violation of my rights of privacy and publicity.
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Media Release Agreement* This field is required.
I have read and understand the Media Release Agreement.
I agree to the terms and conditions of the Media Release Agreement.
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Certification

I hereby certify that the above information is the most up-to-date and correct to the best of my knowledge that I agree to the following as a condition of my participation in Grand Valley State University (GVSU) program or visit and/or related activities.

I give my permission to GVSU and Partners*, St. Mary’s Hospital, Spectrum Health Care System, North Ottawa Community Hospital, Metropolitan Health Care System or other health care providers to provide, seek, obtain, or approve any routine, necessary, or emergency health care during my involvement in the GVSU programs. I understand that this authorization is given in advance of any specific diagnosis, or treatment or medical care being required and is to serve as specific consent to any and all such diagnosis, treatment or hospital care which may be deemed advisable. I understand my rights under the Health Insurance Portability and Accountability Act (HIPAA) and authorize GVSU to release information as necessary for managing program healthcare.

I acknowledge that participation in the camp/activity/visit and/or related activities involves assumed and inherent risk of personal injury. I assume such risk as I participate in all program activities. I release and agree to hold harmless GVSU and Partners*, its Board of Trustees, students and employees from all claims, actions, damages and liabilities for personal injury, damage or illness relating to or arising out of any activity except where the injury, damage or illness is caused by the gross negligence of the university’s or Parnters* employees. I understand that I will be subject to the rules and regulations of the camp/activity/visit and/or related activity. I understand that any person who repeatedly disobeys University/Partner* policies or procedures will be immediately expelled from the program. GVSU and Partners* is not responsible for lost or stolen property.

*Partners (WGVU, Mosaic Film Experience, WMCAT, Steelcase Foundation)
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Consent to Attend* This field is required.
I have read and fully understand the Certification.
I agree to release and indemnify the university and named Partners. I agree to be legally bound by it.
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