STEM Nonprofit Child Participant Signup
Participant Information
Child’s Full Name
Date of Birth
Gender
Female
Male
Non-binary
Other
Prefer not to say
School Name
Current Grade
Parent/Guardian Information
Parent/Guardian Name
Relationship to Child
Parent/Guardian Email
Parent/Guardian Phone
Home Address
Medical and Emergency Information
Allergies or Medical Concerns
Alternate Emergency Contact Name
Emergency Contact Phone
Permissions
I grant permission for my child’s photo/video to be used for nonprofit promotional purposes.
I consent to my child’s participation in STEM nonprofit programs.
Signature
Parent/Guardian Name (Signature)
Date