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NextWave Future Leaders is A Not-For-Profit Charitable Trust. Charity Registration # CC63105

Join NextWave Future Leaders

💡 Real Teens. Real Stories. Real Transformation.

🎥 Watch as Neve, Molly, Aliya & Emma share their life-changing experiences from leadership programs just like the 2025 NextWave Future Leaders Summit.

They came in unsure of themselves, questioning their potential… and left empowered, confident & ready to take on the world. 🌍✨

Teen (13-17 YR) Registration

Participant Information

Salutation *

Mr
Mrs
Ms
Dr
Other
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Full Name *

Date of birth *

How Old Are You On the 12th of April 2025? *

Email *

Mobile/Phone *

Gender *

Male
Female
Non-Binary
Prefer Not To Say
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WhatApp Number

Address

Street Address & Suburb *

City

State

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People"S Republic
Korea, Republic of
Kuwait
Kyrgyzstan
Land Islands
Lao People"S Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
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Vanuatu
Venezuela
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Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Postal code

Participant's Photo *

T-Shirt Size

T-Shirt Sizes *

Unisex/Men's T-Shirt - S
Unisex/Men's T-Shirt - M
Unisex/Men's T-Shirt - L
Unisex/Men's T-Shirt - XL
Unisex/Men's T-Shirt - 2XL
Unisex/Men's T-Shirt - 3XL
Unisex/Men's T-Shirt - 4XL
Unisex/Men's T-Shirt - 5XL
Women's T-Shirt - XS
Women's T-Shirt - S
Women's T-Shirt - M
Women's T-Shirt - L
Women's T-Shirt - XL
Women's T-Shirt - 2XL
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Please Refer To The Charts Below.

Participant Details

What excites you about joining the 2025 Youth Leadership Summit? *

What other contributions have you participated in? *

What are your hobbies, interests & leadership aspirations? *

What are your career goals or dreams for the future? *

What’s one challenge you’re facing right now that you wish you had more support with? *

Whatever you share stays completely confidential, but opening up could be the first step to something better.

Health & Dietary Information

Do you have any medical conditions or take any medication we should be aware of? *

Do you have any dietary restrictions or allergies? *

Primary Doctor’s Name & Contact Info

Parent/Guardian Information

Parent/Guardian 1 Full Name *

Relationship to Participant (1)

Mother
Father
Grandmother
Grandfather
Legal Guardian
Other
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Parent/Guardian 1 Email Address *

Parent/Guardian 1 Contact Number *

Parent/Guardian 2 Full Name

Relationship to Participant (2)

Mother
Father
Grandmother
Grandfather
Legal Guardian
Other
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Parent/Guardian 2 Email Address

Parent/Guardian 2 Contact Number

Consent & Signature

Consent to Confidential Information Collection for Verification Purposes *

I consent that the collection of my information will be held in complete confidence within the guidelines of NextWave Future Leaders private policy & will be for the purpose of verification only.

Voluntary Participation Confirmation for NextWave Future Leaders Program *

I confirm my willingness to participate in the NextWave Future Leaders Program. My involvement is voluntary & I agree to follow all guidelines to ensure a safe & enriching experience.

Agreement to Terms & Voluntary Participation Confirmation *

By ticking this box, I confirm that I have read & agree to all applicable terms, including my voluntary participation & adherence to program rules.

Privacy Policy | Rules & Regulation

Flight Details

Airline Name

Flight Number

Departure Date & Time

Arrival Date & Time

Signature

Signature 11oy6 *

Clear

Teen's Signature

Date Picker 11p6u *

For any questions or concerns about the registration form, please contact our Founding Director, Rani Rangimoekau, at [email protected] or call +64 21 359 481.