Registration Form
November 6, 2026, 4:00 PM-November 8, 2026, 11:30 AM Holiday Inn Newport News-Hampton 980 Omni Blvd. Newport News, VA 23606
Participants Name
*
First Name
Last Name
Participants Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Caregiver Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Caregiver Email
*
example@example.com
Participants Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participants Age
*
Participants Grade
*
Participants School Attending
*
Gender
*
Please Select
Female
Non-Binary
Gender Neutral
Other
How would you identify your race?
*
Please Select
Black/African American
White/Caucasion
Asian
Native American
Hawaiian
Multi-Race
Other
How would you identify your Ethnicity?
*
Please Select
Hispanic
Non-Hispanic
The Summit is Friday, November 6th, 4 PM through Sunday, November 8th, 11:30 AM. Will you be able to attend all days (yes or no)? If no, please explain.
*
What is your t-shirt size (Adult size)?
*
Dietary Ristrictions
None
Vegetarian
Vegan
Please identify if there is another participant(s) that you would like to room with (that participant(s) must be attending as well).
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Please review the Consent and Health Form.
*
Please click
NEXT
to complete the Consent and Health Form.
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