Registration Form for STEM Day
STEM DAY scheduled date: April 21, 2018
Email address *
Student Name *
Your answer
Grade *
Address *
Your answer
City *
Your answer
State *
Your answer
ZIP Code *
Your answer
Phone # *
Your answer
Parents Cell Phone # *
Your answer
Home Phone # *
Your answer
Student's Email Address *
Your answer
School where student is currently enrolled: *
Your answer
In which town? *
Your answer
PERMISSION SLIP FOR PARTICIPATION
1. Parent and student acknowledge and are aware that even with proper supervision, use of protective equipment and strict observance of rules, there are risks inherent in participation in the STEM DAY. Parent and student hereby release, hold harmless, indemnify and discharge Mother Seton Regional High School, its employees, agents and volunteers from all liability for damages, loss or injury to persons or property arising out of or in connection with student's participation in the above described activity that may be filed by, on behalf of, or for the above named student.

2. For purposes of this agreement, liability means all claims, demands, losses, causes of action, suits or judgments of any and every kind that arises from student's participation in the STEM DAY.

3. Parents and student further expressly agree that the foregoing release and waiver provisions are intended to be as broad and inclusive as is permitted by the law and that if any portion of it is help void, voidable, or unenforceable, the remaining portions shall remain in full force and effect.

4. The undersigned has read and voluntarily signs this release and waiver of liability and further agree that no oral representations, statements or inducements, apart from this agreement, have benn made.

I hereby request that my daughter participate in the above STEM DAY program. *
Please type below your daughter's full name:
Your answer
Signature of Parent/Guardian *
By typing your legal name below you acknowledge to electronically sign this form:
Your answer
Date: *
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This form was created inside of Mother Seton Regional High School.