Tech Changers micro:bit pop-in series

Thanks for your interest in Tech Changer's micor:bit pop-in series!
Child's First Name *
Child's Last Name *
Primary Address *
Grade *
Required
I am registering for session... *
School I attend... *
Location of class... *
I am registering for... *
Primary Parent/Caregiver First and Last Name *
Primary Cell Phone *
Primary Home Phone
Primary Email Address *
Emergency Pick Up First and Last Name *
Emergency Pick-Up Relationship (relationship between child and emergency pick-up.) *
Emergency Pick-Up Cell Phone *
Does your child have any limitations or medical conditions that could affect their participation in this class? *
Please explain if you answered yes above. Be sure to include asthma and allergy information.
Acceptance of Waiver and Hold Harmless Agreement* I accept the Waiver and Hold Harmless Agreement. View form at: http://bit.ly/2kIFxUS *
Parental Consent Forms/WaiversPhotography/Media Release Form I grant to Tech Changers the right to take photographs of my child during their after-school programming. I authorize Tech Changers to copyright, use and publish the same in print and/or electronically. I agree that Tech Changers may use such photographs of my child with or without their name and for any lawful purpose, including for example such purposes as news articles, publicity, illustration, advertising, and Web content. Examples of how we use photography online and via twitter can be seen here: http://www.techchangers.org *
Late Pick Up Policy* Please read and accept our Late Pick Up Policy: Thank you in advance for ensuring that your child is picked up on time. In the event of excessive wait time for pick up, the following policies will apply: After one late pick up of 15 minutes or more, there is a $5.00 fee for the first 15 minutes, and $10 fee for the second 15 minutes and each succeeding 15-minute time segments. After 45 minutes, we will reach out to the emergency contacts to request pickup. After two late pick-ups of 15 minutes, we will contact you to discuss terminating your child's participation in the course. *
T-Shirt Size: Please select your student's t-shirt size. T-shirts are not guaranteed, dependent on sponsor donations. *
Gender *
Required
DEMOGRAPHICS: One of our goals is to ensure we are providing programming to a diverse group of girls and boys. Please indicate your ethnicity: *
Submit
Never submit passwords through Google Forms.
This form was created inside of Tech Changers Inc.. Report Abuse