Global Innovation Race 2025

Individual Registration Form

Student Information

Student First Name*

Student Last Name*

Preferred Name

What name would you like to be used by our team?

Student Email*

Student Birthday*

Year-Month-Day

Preferred Pronouns*

Student School Name*

Please use the full school name

Student School Website URL*

Primary Parent/Guardian Information

Please provide us with the contact information for the Primary Parent/Guardian for this student. You may list a secondary parent/guardian as an emergency contact below.

First Name*

Last Name*

Email*

Phone Number*

Please select your Country Code followed by 10-digit number (ie. +1 123-456-7890)

Relationship to Student*

Street Address*

City*

State/Province*

Country*

Postal/Zip code*

Emergency Contact Information

In case of an emergency, we will contact the emergency contact(s) listed below to inform them of the situation and seek guidance on how to proceed. It's important to ensure that the emergency contact information is accurate and up to date to facilitate quick and effective communication.

You may repeat the above Primary Parent/Guardian or add an additional emergency contact in the space below.

Primary Contact Full Name*

Primary Contact Relationship to Student*

Primary Contact Phone Number*

Primary Contact Email*

Secondary Contact Full Name*

Secondary Contact Relationship to Student*

Secondary Contact Phone Number*

Secondary Contact Email*

Travel Information

We collect travel information to ensure that all participant travel is properly coordinated and that they can arrive at their destination safely and on time.

If you are traveling as part of a group, please coordinate your travel arrangements with your chaperone to ensure accuracy.

Do you require airport pick-up?*

Do you require airport drop-off?*

Medical & Insurance Information

Digital Media Academy strongly recommends all participants seek medical insurance coverage for the full duration of Global Innovation Race 2025 (July 17-27, 2024) should any incidents or accidents require medical assistance. If seeking International Travel Medical Insurance Coverage, we recommend you contact Guard.me to seek coverage.

Does the participant have any chronic or acute medical conditions that would require any accommodation to fully participate in the program/activity?*

Does the participant take any medications or require any medications to be administered in case of an
emergency?*

Does the participant have any allergies to medications, food, pollen, insect bites, etc?*

Is the participant covered by medical/travel insurance?*

Stanford University Liability Waiver

As a Stanford-sponsored program, all parents/guardians of Global Innovation Race participants are required to review and sign the Stanford Liability Waiver. Please download, review, sign, and re-upload the below-linked form:

https://rde.stanford.edu/sites/default/files/2024-02/2024%20Stanford%20University%20Waiver.pdf

General Liability Waiver and Consent

I acknowledge that as the parent/guardian of a participant who is under the age of 18, I understand and accept the risks associated with the program, and I will be responsible for any and all medical expenses related to the participant's illness or injury during the program.*

I acknowledge that the participating student is responsible for their own personal property during the program and that the organizers will not be liable for any loss, damage, or theft of personal property.*

I give my consent for any photographs, videos, or other media of my participating student taken during the program to be used for promotional or educational purposes.

I, as the parent/guardian of the participating student, understand and agree that my child or child-in-care will adhere to the conduct policies as stated in the Terms & Conditions found at https://digitalmediaacademy.org/terms-and-conditions/ during their participation in the Global Innovation Race 2024 from July 17-27, 2024. I recognize that a breach in conduct may result in expulsion or dismissal from Global Innovation Race 2024.*

I confirm that the above-provided health and medical information is true and accurate to the best of my knowledge.*

As the parent/guardian of the participant, I hereby give my consent to Digital Media Academy to seek emergency medical treatment on behalf of my child or child-in-care if it is deemed necessary for their health and safety.*