• 2026 Black Male Youth Summit Registration Form

  • The City of Bloomington Commission on the Status of Black Males will host the Black Male Youth Summit at Bloomington's City Hall (401 N. Morton St., Bloomington, IN 47404) Thursday, Sept. 17th from 10:00 AM -2:00 PM. Registered middle and high school attendees will be excused from class to attend the event. Registration for the Black Male Youth Summit is free of charge. Although focused on African American and Latino middle and high school-aged male-identifying students, all are welcome to attend.

    Students are encouraged to ride the school provided transportation to and from Bloomington's City Hall. Parking is not available for students in the Bloomington's City Hall parking lot. 

  • GUARDIAN INFORMATION

  • Format: (000) 000-0000.

  • EMERGENCY CONTACT

  • Format: (000) 000-0000.

  • STUDENT REGISTRATION

    STUDENT INFORMATION
  • Format: (000) 000-0000.
  • STUDENT SCHOOL*
  • This student will:*
  • Format: (000) 000-0000.

  • PARENT ACKNOWLEDGMENT

    Photo Release
  • Do you authorize permission your student to be photographed or recorded during the event, and for those images or video to be used by the City of Bloomington for promotional or informational purposes?*
  • Should be Empty: