Girls' Summit Participant Registration Form

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Date: Saturday, April 26 2025 | 8:30am - 3:00pm

Location: Gateway Center at SUNY ESF Campus

Cost: FREE thanks to our friends at Sidney Federal Credit Union (SFCU)! *Lunch included

Details: Registration opens 8:30am, activities begin at 9:15am. Parents should arrive for pickup by 3pm.

Girls' Summit is a hands-on S.T.E.A.M.-based (Science, Technology, Engineering, Art, and Math) career exploration day that introduces students in grades 5th-10th to “non-traditional” fields through a keynote address, a series of workshops, and panel discussions comprised of local women in business and STEM careers. Each participant will rotate through 4 of 8 workshops on the ESF campus. Past workshop topics have included paper-making and testing, building watershed models, constructing wind turbines, heart beat regulation, Science for Health and Life, coding, Scratch software, and fermentation.

The following questions are asked due to our status as a nonprofit and the funding sources we receive. We have to report the general demographics of those who access our programs. This helps us better serve YOU because with this information we can fill gaps in our programming and ensure that we are providing a quality experience for all. Please know that this information does not remain connected to your name/identifying information but instead is analyzed as percentages overall.

Please contact Caitlyn Copfer at the YWCA with any questions: 315-424-0040 or ccopfer@ywca-syracuse.org.

Participant Name (first and last) *

Date of Birth *

YYYY

Grade *

School *

Mailing Address *

Zip Code *

Gender *

Race *

Ethnicity *

Do you have a workshop partner? *

Yes

If yes, please write name below

Dietary Needs of the participant

Parent Name (first and last) *

Phone Number *

Emergency Contact Name and Phone Number *

Number of people in household *

Household Income *

Consent *

As legal guardian of the child, I give my permission for them to attend the Girls Inc. at YWCA Girls Summit.

In case of illness or emergency, I understand that every effort will be made to contact emergency contact listed and if no contact can be made, I hereby give authorization to YWCA of Syracuse & Onondaga County to seek medical treatment and if needed arrange for transportation.

By submitting this registration form, I grant permission for my child to be photographed during this program. I grant permission for SUNY ESF, SU STEP program, YWCA of Syracuse & Onondaga County, and their agents, successors, and assigns the free and unrestricted right to use the photos and my child’s name, for publicity and for use in promotional material in any legal manner, newspaper, television, and/or on website and waive the right to inspect the finished promotional product.

I agree that the information on this form may be released to Syracuse University, ESF, and any other partners affiliated with this event for purposes related to programming, education, and Covid 19 contact tracing.

I give permission for my child to fill out the Girls Inc. assessment survey during this event.

I understand that registration begins at 8:30am and the event ends at 3pm. Items will be raffled during the closing ceremony and only children present at that time will be able to claim a prize.

Required

Electronic Signature of Parent *

Submit

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