BOLT at Disney Registration Form

BOLT Student Leadership Program At Disney REGISTRATION

June 23rd – June 26th, 2024 at Walt Disney World® Resort, Florida

Join an unforgettable program with students from around the country, using the Walt Disney World® parks as a magical classroom!

Are you registering with a group or as an individual?*
- group
- individual
What group are you with?*
What is the name of your group?
Don't see the name of your group listed? Interested in bringing a group? Contact: stephen@pegasussprings.org
Choose the registration that best fits your group size and timing.*
Group size must be three or more to qualify.
Choose the registration that fits for you.*
Includes a 3-day Disney park-hopper ticket (a $550 value), a Disney "Imagination Campus" program, an EPCOT dessert and VIP firework viewing event ($100 value), 3 days of BOLT programming, 3 days lunch certificates ($100 value), 3 BOLT t-shirts, and discounted hotel rates and park tickets available to parents/chaperones of students.
Add a Companion 3-Day Park Hopper pass ($450)?
- yes
- no
Add a companion ticket for our private EPCOT dessert party and firework viewing?
Guardian Name*
First Last
Guardian Email*
Guardian Phone Number*
Student Name*
First Last
Student Email*
Student Phone Number*
Student Home Address*
Street Address Address Line 2 City State ZIP Code
Student Age*
As of 6/1/2022
Student First Name*
As it should appear on a nametag
Student Current Grade*
Name of School Student Attends*
Student T-Shirt Size*
How many times (including this BOLT session) have you attended BOLT?*
Does student have any food allergies or restrictions?*
This information will be sent to Disney Culinary Services to meet your dietary needs. (If none, please enter "None.")
Does student have any non-food allergies (e.g. bee stings, medications, fabrics)?*
(If none, please enter "None.")
Companion Name*
Please enter the name of the companion who will be accompanying the registered student.
First Last
Companion Email
(If different from Guardian Email above.)
Companion Phone Number
(If different from Guardian Phone Number above.)
Coupon
Total
$0.00
Payment Plan:
Early-Bird rates require either a completed purchase order by November 30, 2023—or, if paying by check or credit card, an initial deposit of 30% must be made by Nov. 30, 2023; a second (30%) deposit by Feb. 15, 2024; and a final payment (40%) by May 15, 2024.
Standard Registration rates require a completed purchase order or a credit card transaction for the full amount by May 15, 2024.
If not paid in full at registration, invoices will be sent for payment. For check or credit card registrations, installment payments must be made according to the above timeline in order to retain the “early-bird” discounted rate. For summit attendance, all registrations require full payment no later than May 23, 2024
Cancellation Requests
Cancellation requests must be submitted to Pegasus Springs Education Collective by email no later than May 15, 2024. Registrants who are unable to attend may either designate a non-registered person to attend in their place or request a refund. (A $35 processing fee will be charged for each registration refund.)
After May 15, 2024, registrants may only transfer their registration to a non-registered person to attend the event in their place, with registration confirmation or written authorization from the original registrant. No refunds will be issued after May 15, 2024.
Permissions
By registering and participating in the event, you understand that at this event or related activities, you and/or your child/student (if participating) may be photographed. As a participant in the event or activity, you agree to allow your and/or your child’s/student’s photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and assigns.
Pegasus Springs Education Collective is a nonprofit organization. As part of the resort agreement for this event, Pegasus Springs Education Collective receives an $11 rebate for each room night at the hotel occupied and paid for by event coordinators and attendees at the group room rates during the dates of the designated room block. All funding from any rebate that is generated is used to offset the other expenses associated with offering this specific event to attendees.
By participating in the event, you consent for you and/or your child/student to receive medical treatment that may be deemed advisable in an emergency or in the event of injury, accident, and/or illness during this activity or event. You are aware that there is no health insurance coverage associated with this event or activities and that participants should carry their own health insurance. If medical treatment is needed as a result of participation in this activity or event, travel to and from the activity or event (including air travel), or any activity incidental to this event, you agree to be financially responsible for any costs incurred as a result of such treatment.
By registering, you certify that you are voluntarily participating in this event and assume all risks for participation. You indemnify and hold harmless Pegasus Springs Education Collective, its directors, partner organizations, event coordinators, and volunteers from any and all liabilities or claims as a result of participating in this activity or event. (For student programs, parents/ guardians/ chaperones will also be asked to sign a release and permission form for their child’s/student’s participation.)
Payment Options
Please select your preferred payment option:
- Pay In Full Now (Proceed to PayPal)
- Payment in Three Installments with credit card (we will invoice you)
- Purchase Order (we will invoice you)
Purchase order number
Name for invoice
First Last
Email for invoice
Address for invoice
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Comments
This field is for validation purposes and should be left unchanged.

BOLT Student Leadership Program At Disney REGISTRATION

Payment Options