Girls 4 Science Program Application - Malcolm X (Summer 2024)

Tu navegador no tiene JavaScript activado, por lo cual no se puede abrir este archivo. Actívalo y vuelve a cargarlo.

Iniciar sesión en Google para guardar lo que llevas hecho. Más información

Personal Information

Site Location *

Are you a new participant? *

Does returning student need a replacement T-shirt ? *

Select T-shirt size (New students, Returning student replacement):

NOTE: All shirts are adult size.

Quarter *

Student First Name *

Student Last Name *

Home Address *

City *

State *

Zip Code *

Student Mobile Phone

Student Home Phone

Student Email Address

Student Age *

Ethnicity *

Check all that apply.

American Indian or Alaska Native including Original Peoples of the America

Asian(including Indian subcontinent Middle Eastern and Philippines)

Black or African American(Including Africa and the caribbean)

Hispanic or Latino

Mixed Race

Native Hawaiian or Other Pacific Islander

Prefer Not to List

White (Including People of European Ancestry

Otro:

EDUCATIONAL INFORMATION

What is your grade level? *

Please list your school name.

City where your school is located.

PARENTAL INFORMATION

Parent First Name *

Parent Last Name *

Does your child receive free/or reduced lunch? *

Yes

Language spoken at home:

Click Here (if address is the same as the student).

Same as student mailing address.

Address

City

State

Zip Code

Parent Mobile Phone *

Parent Work Phone *

Parent Email Address *

What dates will the participant NOT be able to attend?

Check all that apply.

July 6

July 13

July 20

July 27

August 3

August 10

EMERGENCY CONTACT INFORMATION

Please complete.

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship *

FOR NEW STUDENTS ONLY!

RELEASE AUTHORIZATIONS

Please click on the links below and review the release forms. Please enter your name for each release to confirm your consent.

Harmless Waiver Release *

Click on this link to view this release: https://docs.google.com/a/girls4science.org/document/d/1E_GCh31ySdgOgV0XBzDNW-VYCa0xnJbLpewdMYAoBkk/edit?usp=sharing. Please type your name below to authorize your consent.

Photograph Consent and Waiver Release *

Click on this link to view this release: https://docs.google.com/a/girls4science.org/document/d/1DKP7btkd00IWeqC--VINIyJ-LZMohIbPSXeOZyquEos/edit?usp=sharing. Please type your name below to authorize your consent.

Enviar

Borrar formulario

Nunca envíes contraseñas a través de Formularios de Google.

Formularios

Este contenido no ha sido creado ni aprobado por Google.