NextGen Roundtable: Dallas Youth Summit Registration Form

Congratulations! You have been selected to participate in the NextGen Roundtable: Dallas Youth Summit! The summit will take place on April 24, 2025, from 9:00am-3:45pm, at the Kay Bailey Hutchison Convention Center Dallas. To secure your participation in the event, please complete the registration form below.

*Transportation to and from the event is not provided.

I am a...(Required)

Teacher Name(Required)

Job Title(Required)

Mobile Phone Number(Required)

School Email(Required)

Secondary Email(Required)

Full School Name(Required)

Other School (please list)

School Address(Required)

Number of students participating:(Required)

Grades of Participating Students(Required)

Grade 9

Grade 10

Grade 11

Grade 12

By signing below, the undersigned confirms it has the authority to enter into this Enrollment Agreement on behalf of Participant School/Organization and acknowledges that they have read and agree to the Terms and Conditions.

Teacher Signature(Required)

Teacher Date(Required)

Student Name(Required)

Student School Email(Required)

Student Personal Email(Required)

Student Cell Phone(Required)

Home Address(Required)

Full School Name Student(Required)

Other School (please list)

Organizations you are affiliated with:

YMCA

Gear Up

Other

Other Organization

Current Grade (select one)(Required)

Grade 9

Grade 10

Grade 11

Grade 12

Participating Teacher Name(Required)

Participating Teacher Email(Required)

Parent/Guardian Name(Required)

Parent/Guardian Cell Phone(Required)

Parent/Guardian Email(Required)

I, the parent or guardian of the student participant, confirm and acknowledge that I have read and agree to the Terms and Conditions.

Parent/Guardian Signature(Required)

Date(Required)