Technocopia Student Registration
***This form is to be filled out only by persons aged 18 or older***
Contact Info
Name (Last, First) *
Your answer
Phone *
Your answer
Email *
Your answer
Students Under 18
If you are accompanying one or more students between the ages of 5 to 17, please fill out this section in addition. For multiple students, please list names and birth dates vertically.
Name(s)
Your answer
Date of Birth(s)
mm/dd/yyyy
Your answer
Emergency Contact
In the event of an emergency, the first person we should notify.
Name *
Your answer
Relation *
Your answer
Phone *
List more than one if necessary.
Your answer
Code of Conduct
*
Required
Release and Waiver of Liability
Please review our Release and Waiver of Liability agreement here:

https://drive.google.com/file/d/0B1pu25WzUJBhaHg3dUp2cEZTcG8/view?usp=sharing

*
Required
Media Release
Technocopia uses several forms of media for promotional and educational purposes such as photo, video and audio. From time to time, members may be asked to be recorded or be made aware that a recording is taking place. Recordings may be published publicly on the web or in hard copy. If a member wishes to remain anonymous or undocumented, it is their responsibility to inform whoever is conducting the recording at that time.
*
Required
Electronic Signature
I have read and understand all documents included in this form and agree to their terms and conditions.
Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This form was created inside of Technocopia, Co.. Report Abuse - Terms of Service