MakerSpace Monday Registration
Thanks for your interest in TechChanger MakerSpace Mondays! Sign up below to become part of the group. Weekly participation is NOT required..just come when you can, have fun and learn about the world of computing!
* Required
First Name
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Your answer
Last Name
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Your answer
Email Address
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Your answer
Grade
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6th
7th
8th
9th
10th
11th
12th
Other:
Required
School Name
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Your answer
Primary Parent/Caregiver First and Last Name
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Your answer
Primary Cell Phone
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Your answer
Primary Home Phone
Your answer
Primary Email Address
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Your answer
Emergency Pick Up First and Last Name
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Your answer
Emergency Pick-Up Relationship (relationship between child and emergency pick-up.)
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Your answer
Emergency Pick-Up Cell Phone
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Your answer
Does you have any limitations or medical conditions that could affect their participation in this class?
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Yes
No
Other:
Please explain if you answered yes above. Be sure to include asthma and allergy information.
Your answer
Acceptance of Waiver and Hold Harmless Agreement* I accept the Waiver and Hold Harmless Agreement. If under 18 parents must agree and sign form on first day of attendance. View form at:
http://bit.ly/2kIFxUS
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Yes
DEMOGRAPHICS: One of our goals is to ensure we are providing programming to a diverse group of girls and boys. Please indicate your ethnicity:
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Asian
Hispanic/Latino of any race
White
Black/African-American
Native Hawaiian or Other Pacific Islander
Two or more races
I choose not to answer
Other:
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