STEM Saturday
Event Timing: January 26, 2019 2pm - 4pm
Event Address: 805 E. Broad Ave, Albany, Ga 31705
Event Cost: FREE
Contact us at (770) 282-7432 or
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Email *
Student First Name *
Student Last Name *
Gender *
Date of Birth *
Does The Student Have an Epi-Pen? *
Does The Student Have an Inhaler? *
Any known allergies? *
Parent Name *
Home Phone # *
Guardian Cell # *
Guardian Email *
I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. Please type your First and Last name. *
I understand that Balancing The Equation 21st Century Learning, Inc (501c3) will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian. Please type your First and Last Name. *
Photo Release I hereby give permission for my child to be photographed during the STEM Saturday Session. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand although my child's photograph may be used for advertising, his or her identity will not be disclosed. I do not expect compensation and that all photos are property of Balancing The Equation 21st Century Learning, Inc. Please type your First and Last name. *
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