2025 Conference Pre-Registration

First name

Last name

Email

Grade Level

4th or 5th

Middle School (6th, 7th, 8th)

High School (9th, 10th, 11th, 12th)

Parent/Guardian First & Last Name

Parent/Guardian Phone Number

Emergency Contact Name & Relationship

Emergency Contact Phone Number

How did you hear about this event?

Please list any allergies and/or health limitations

Media Release: By registering, you consent to the use of your name, image, and event photos/videos for promotional purposes by Queens to Be Academy. If you do not wish to have your image or likeness used, please indicate below.

Our registration fee helps us continue to provide a quality event for all attendees. If you are unable to pay the fee, but would still like your child to attend, please email deja@dejacroftllc.com

Paid on Next Page

Would you like to make a donation? (THIS IS AN OPTIONAL DONATION. THIS IS SEPARATE FROM YOUR $10 REGISTRATION FEE)

$10

$20

$30