Educator & Adult Registration

Congratulations on being accepted to the Ultimate Life Summit. Please review the important summit information below before submitting your registration form.

Educator & Adult Information

Registration is required for all educators and adults attending the Ultimate Life Summit.

Room & Board—Hotel room costs are included in the tuition for 7 days. Individual rooms are not provided, and guests will share a room with another adult participant. You may upgrade to a single room for an additional cost, subject to hotel costs and availability.

Excursions & Park Visits - On Wednesday, we will spend the day at Magic Kingdom and Hollywood Studios. If you’re not interested in participating, let us know as soon as possible.

Email Judi Vargas-Prada at judi@magicwandfoundation.org to inquire about room & board options, park visits, or any other questions you may have.

Complete Registration Form

Name

First Name

Last Name

Phone

(###)

###

####

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What is the name of your school or organization?

What is your t-shirt size

We provide all attendees a t-shirt for each day of the summit.

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

What is your relationship to the Emergency Contact?

Medical History

Medical history is required for all educators attending the Ultimate Life Summit and is only to be used in the event of a medical emergency during the summit.

Describe any chronic or serious medical conditions.

Indicate N/A (Not applicable) if the statement or question is not relevant to you.

For any medical conditions listed above, provide the usual method of treatment.

Indicate N/A (Not applicable) if the statement or question is not relevant to you.

Indicate any current medications taken daily and the dosage.

Indicate N/A (Not applicable) if the statement or question is not relevant to you.

List any allergies to medications.

Indicate N/A (Not applicable) if the statement or question is not relevant to you.

List any allergies to food or food preferences. (i.e., vegetarian, gluten-free, etc?)

Indicate N/A (Not applicable) if the statement or question is not relevant to you.

Will you have medical insurance at the time of the summit?

Yes

No

Photography & Video Release

I hereby grant permission to the Magic Wand Foundation, its agents, employees, volunteers, partners, and staff and assign the irrevocable and unrestricted right to capture, use, publish, and distribute photographs and/or video images of me (or the minor named above for whom I am legally responsible), without compensation, for the purpose of editorial, educational, promotional, and any other purpose in any medium for any lawful purpose as part of the Magic Wand Foundation’s activities, including but not limited to websites, newsletters, brochures, advertisements, and public displays. I understand and agree that: Photos and videos will be used without any obligation or compensation to me or my family. This release applies to photographic, audio, or video recordings collected as part of the sessions, events, or activities associated with the Ultimate Life Summit. All such photos and video recordings are the property of the Magic Wand Foundation. I waive any right to inspect or approve the finished photographs or electronic matter that may be used now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image or recording. I hereby hold harmless and release and forever discharge the Magic Wand Foundation from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

Consent & Agree

I have read the terms and understand and consent to the terms above

I do not consent to the terms above.