Startup High School Workshop Albany, New York - Individual Registration Form 2020

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Individual Student Registration form for Startup High School Workshop - Albany, New York

Email *

What is your last name? *

What is your first name? *

What is your cell phone number? *

What is your group or team's name? (So we know what group you are a part of.) *

Who is your group or team leader? (Primary contact person for group/team). *

What is your group or team leader's cell phone number? (Primary contact person for group/team). *

Please list the names of all your team members (First and Last Names). *

What school do you attend? *

What grade are you currently in? *

9th

10th

11th

12th

What is your parent/guardian's name? *

What is your parent/guardian's cell phone number? *

Emergency Contact Person's Name. If it is the same as above, then indicate "same as above" in the space provided. *

Emergency Contact's cell phone number. *

Tell us a little about yourself (a couple of sentences....."In my spare time I like to......" or "My favorite subjects in school are.....") *

Do you have any dietary restrictions or food allergies? *

Yes. If yes, or other dietary restriction - please list below:

Please indicate, food allergens or other dietary restrictions. If none, put N/A. *

Is there anything else you would like us to know?

Send me a copy of my responses.

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