Spark Saturdays Spring 2017 Registration
Student Name *
Your answer
High School *
Your answer
Grade *
Programming Experience *
Does your student have experience with programming?
Parent / Guardian Name *
Your answer
Email Address *
used for communication about sessions
Your answer
Primary Phone *
No dashes, parentheses, or spaces, please.
Your answer
Emergency Contact *
someone other than the provided parent / guardian
Your answer
Emergency Contact Primary Phone *
No dashes, parentheses, or spaces, please.
Your answer
Emergency Contact Relationship to Student
Your answer
If the student has any chronic acute medical problems, please provide details.
Your answer
If the student needs to take medication during the session, please provide details.
Your answer
If the student has any dietary restrictions or allergies, please provide details.
Your answer
People Authorized for Pickup *
names of those people who can pick your student up
Your answer
Is the student authorized to leave the sessions without supervision? *
When the session ends, does the student have your permission to get home on their own?
How did you hear about ECE Outreach and SPARK Saturdays?
Your answer
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