Student Registration Form
Event Timing: 10am-12:00 pm Saturdays (Every 3rd of the month)-Starting Sept 26, 2020 to April 17, 2021

Registration fees:
New Member - $55
Returning Member - $45
Late Registration (After October 3rd)- $70

Contact us at
Email address *
Parent/Guardian Full Name *
Relationship to Child *
Child's First Name *
Child's Date of Birth *
Child's Last Name *
Child's Gender *
What grade is your child in? *
Please list any other students you are registering (*NOTE* Each student MUST be registered separately. A separate application MUST be filled out for each student)
What type of school does your child attend ? *
School Name *
School's City, State, and Zip Code *
Child's Race & Ethnicity *
Please list any medical/mobility/mental health concerns of which we should be aware of. The program will accept children with moderate special needs as long as the program can reasonably accommodate their needs and their presence does not endanger the health and safety of other children and the staff. *
Volunteers are not professionally trained or certified to handle certain types of behaviors. Place "N/A" for not applicable.
Please list any allergies your child may have and their symptoms. Place "N/A" for not applicable. *
Emergency Contacts w/phone number and relationship to child (Must be different than Parent/Guardian) *
Is your child a NSBE Jr. member ? *
T-Shirt Size? (Note: T-shirts are in Adult sizes) *
NSBE Jr. Member Information (Chapter Name and ID number) Not a Member Yet? Enter "non-member" *
Do you qualify for APEX membership?: High School NSBE Jr. members with a GPA of 3.5 or better. Please bring copy of last year's transcript to the first meeting for verification. APEX members are eligible for discount registration and a special reception at National Convention. *
Parents are an essential component to a successful NSBE Jr. Chapter. In addition to monthly meeting programming for academic enrichment and the 3C's (Character, College and Career) development, students will also have the opportunity for HOMEWORK HELP to aid academic excellence. This homework help will be virtual. Students can pose their questions and one of our members will answer the question during our weekly session. *
We have made every effort to add exciting robust programming this year to gauge the interest of our students. Please list specific topics your child may have interest in for in the following areas: STEM/STEAM, Academic Enrichment, Competition, and 3C’s (Character, College and Career Development). *
A copy of your responses will be emailed to the address you provided.
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