Registration Forms: 2018 Young Women's Design and Building Institute at Girls Garage
We can't wait to see you this summer! Please complete this registration form in its entirety. Some of the questions may be repetitive from the application (sorry), but all are important to our preparation for your experience this summer. Thank you!

Registration forms must be completed by April 1, 2018 in order to confirm your participation.

Participant First Name *
Your answer
Participant Last Name *
Your answer
Which session were you accepted for? *
Participant email address
(If you have one. If not, please leave blank)
Your answer
Participant cell phone number (where we can reach you before and during the Institute)
(If you have one. If not, please leave blank)
Your answer
Street Address (where we can send materials to you before the Institute) *
Your answer
City, State, Zip Code *
Your answer
Date of birth (must be 13-17 years old by first day of program): *
MM
/
DD
/
YYYY
Grade Level (now, 2017-2018 school year) *
Current school attending (2017–18): *
Your answer
How will you be getting to and from Girls Garage each day? (parent, Bart, bike, etc) *
Your answer
What is one thing you're eager to learn at the Institute this summer? *
Your answer
What size t-shirt would you like? (Adult Unisex) *
Do you have any allergies? If none, please say "NONE" *
Your answer
Do you have any dietary restrictions? If none, please say "NONE" *
Your answer
Do you have any medical conditions, take any medication (if so, what and what dosage), or have any other limitations you'd like us to be aware of? If none, please say "NONE" *
Your answer
Name and contact info for your doctor:
Your answer
Primary Parent/Guardian First name: *
Your answer
Primary Parent/Guardian Last name: *
Your answer
Primary Parent/Guardian Email address: *
Your answer
Primary Parent/Guardian phone number: *
Your answer
Emergency Contact 1: Full Name *
Your answer
Emergency Contact 1: Relationship to Participant *
Your answer
Emergency Contact 1: Phone Number *
Your answer
Emergency Contact 2: Full Name *
Your answer
Emergency Contact 2: Relationship to Participant *
Your answer
Emergency Contact 2: Phone Number *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Project H Design. Report Abuse - Terms of Service