WIT Microsoft Girls Workshop Sign-Up

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All 5th through 8th grade girls are invited to participate in our third annual WIT Wisconsin - Microsoft Girls Workshop! This event is sponsored by Kimberly-Clark who has generously offered to provide Adafruits and a pizza dinner and for all participants. Girls who attend will discover new technology through the use of the Adafruits Playground Express circuit boards, as well as hear from female role models in the tech world who are excited to share their passion for computer science!

Wednesday, April 17, 2024
4:00-6:00 P.M.
J.R.Gerritts Middle School LMC

Participants will need to bring their Chromebooks with them to the middle school in order to complete the activities.

Student First Name: *

Student Last Name: *

School: *

JRG Middle

Mapleview Intermediate

Woodland Intermediate

Does your child have a health condition, including allergies, school staff should be aware of? *

Yes

If yes, please explain:

Are health forms on file for the current school year for the conditions listed above? *

Yes

No health conditions

Emergency contact name and relationship: *

Emergency contact phone number: *

Family physician: *

Family physician phone number: *

Hospital preference: *

Emergency Medications

Please be aware that emergency medications that are provided for use during the school day will not be accessible after school hours. Parents and students must plan ahead to have emergency medication available. If an emergency arises and a student does not have their emergency medication available, 911 will be called.

Parent Name: *

Parent Email: *

Parent Permission. Checking the boxes below acts as your signature. *

I give permission for my child to participate in the workshop. I understand that I will need to provide transportation to and from the event.

I agree to the Kimberly Clark Photo Release, as described below.

Required

Kimberly Clark Photo Release

Kimberly Clark may use and publish the name and/or likeness of my minor child (under age 18) identified below in all forms and media. This includes photography, film, tape, digital or any other form, and on K-C’s internal and external websites. This permission does not have a time limit and applies to use in any manner, anywhere in the world. K-C may make alterations to the likeness of my minor child. K-C may copyright the likeness of my minor child.

I waive any right to inspect or approve any finished work containing my minor child’s name and/or likeness. I hereby release K-C from all claims and liability relating to its reproduction of my minor child’s name and/or likeness as described above. I understand that K-C will be relying on this permission and that I may not revoke this permission without K-C’s consent. I understand that “K-C” means Kimberly-Clark Corporation, its subsidiaries, legal representatives, agents and assigns.

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