Student Registration

Name *

First Name

Last Name

Birthdate

Helps with consent and programing needs.

MM

DD

YYYY

Parent/Guardian Phone Number *

(###)

###

####

Emergency Contact Phone Number (if different)

(###)

###

####

Photo/media release (for social media & publications) *

By registering for this event, I give permission for photos, videos, or recordings of me/my student taken during the conference to be used by LNESC and LULAC for social media, websites, and promotional materials. I understand these images may be shared publicly and will not be used for commercial purposes.

I agree

I do not agree

Medical release / permission to treat in emergencies *

By registering for this event, I authorize the LNESC/LULAC staff and designated chaperones to act on my/my student’s behalf in seeking emergency medical care if necessary. I understand every effort will be made to contact a parent/guardian before treatment, but in the event they cannot be reached, I consent to medical treatment as deemed necessary by medical professionals.

I agree

Code of conduct acknowledgment (behavior expectations, boundaries, etc.) *

All participants of the LULAC NW Student Conference are expected to: Respect others – Be courteous to peers, advisors, presenters, staff, and volunteers. Participate fully – Be on time, attend all assigned sessions, and engage positively. Behave responsibly – No disruptive behavior, harassment, discrimination, or inappropriate language. Maintain boundaries – No drugs, alcohol, vaping, or inappropriate relationships/behavior. Stay safe – Follow all instructions from staff/chaperones. Do not leave conference activities without permission. Take care of the space – Keep facilities clean and treat all property with care. Consequences: Students who violate the Code of Conduct may be asked to leave the event, and their school/parents will be notified.

I have read and agree to follow the Code of Conduct.

Parent/Guardian/Advisor has reviewed and agrees.