Hansen Elementary Tuesday 2018-19
Brick Challenge/Galileo Technic for grades 1-5
Parent Last Name
Parent First Name
Student Name (First and Last)
Has your student participated with us before? Please check all that apply.
All of last year
Some of last year
Alternate Phone Number
Emergency Contact Name and Phone Number
Session(s) I would like my child to attend
Session 1 (full- now placing on the waitlist)
Payment Payment is due before the beginning of each session. You can pay at
. You can also make arrangements for autopay. Photo/Video Release I give permission for photos/videos of myself and my child(ren) to be used by Puget Sound e² Young Engineers and e² Young Engineers on its local and corporate websites and in other marketing materials in original, edited or altered form to promote Puget Sound e² Young Engineers. Full last names will not appear in the photos/videos. I agree that there will be no compensation to the child, parent or guardian, and e² Young Engineers has no obligation to identify or give any credit to me or the child(ren). I agree that e² Young Engineers shall have unlimited rights to use the photos/videos for any purposes stated or related to the above. I release, discharge and hold harmless e² Young Engineers and their owners, agents, officers and employees from any and all actions, claims for damages, costs or expenses, including attorney’s fees, which relate to or arise out of the use of the photographs or videos including but not limited to claims for defamation or invasion of privacy. I represent and warrant that I am the parent or legal guardian of the e² Young Engineers student(s) named below, authorized to grant this permission on behalf of the students and myself, and I indemnify, defend and hold harmless e² Young Engineers from any inaccuracy in this representation and warranty. I authorize the assignment of this release and I authorize any assignee to rely on this instrument, but only for the promotion of e² Young Engineers. I give permission for my child(ren) to participate in Brick Challenge, offered by e² Young Engineers. By typing your name below, you agree to the above.
A copy of your responses will be emailed to the address you provided.
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