Autism Tech Training Registration Form
Candidates Name *
Your answer
Candidates Email Address *
Your answer
Highest Level of Education *
Level of IT proficiency *
Learning Disability *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Email *
Your answer
Parent/Guardian Mobile Number *
Your answer
Emergency Contact Person
Name *
Your answer
Relationship *
Your answer
Mobile Number *
Your answer
How did you hear about the program *
Waiver
"I hereby give my consent, and acknowledge that:

I consent to my child, named above, to undertake activities with Strathmore University-@iLabAfrica Research Centre , including participation in any outdoor learning activities organized by Strathmore University-@iLabAfrica Research Centre during class time.

I acknowledge that all reasonable and due care will be taken to keep my child safe and secure at all times while he/she is under Strathmore University-@iLabAfrica Research Centre care. Strathmore University-@iLabAfrica Research Centre and its partners, officers, employees, agents, volunteers and representatives will however not be held responsible for any personal injury, accident, property damage or loss sustained as a result of my child's participation in any learning activities arising out of any cause beyond Strathmore University-@iLabAfrica Research Centres’ control.

I consent to the use of photographs or video footage of my child, on Strathmore University-@iLabAfrica Research Centre websites, in newsletters, publications, and other media. I understand that this consent may be withdrawn by me at any time, upon written notice.

In agreeing to this Consent and Waiver, I am not relying on any oral or written representation or statements made by Strathmore University-@iLabAfrica Research Centre and its partners, agents, employees, or authorized volunteers, to induce me to permit my child to participate in the program, other than those set out in this Consent and Waiver. "

Name of Parent/Guardian *
Your answer
Signature (Initials) *
Your answer
Date *
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