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4th ANNUAL STEMFEST REGISTRATION FORM
This event is completely free to everyone. Please complete the form below, in order to pre-register for the upcoming STEMFEST Session on December 9, 2017
Child's Name
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First
Last
Child's Sex
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Please select
Male
Female
Child's Age
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Child's Grade
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Child's School
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Parent/Guardian's Name
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First
Last
Parent/Guardian's Email
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Parent/Guardian's Phone
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Zip Code
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Does your child have allergies? If so, please list them:
Media and Liability Release
Child's Name
*
First
Last
Additional Child's Name
First
Last
Additional Child's Name
First
Last
Additional Child's Name
First
Last
Additional Child's Name
First
Last
Photo and Video Authorization Release
I hereby acknowledge and grant STEM NOLA, its photographers, videographers, representatives, and employees the final right and permission, to take photographs, and/or videos of me and/or my child while engaged in STEM NOLA activities; with the right to copyright, use and publish in print and/or electronically throughout the world with or without names for any lawful purpose. I forever release and discharge STEM NOLA and its assigns from any and all claims, actions and demands arising out of or in connection with the use of photographs and or videos. I understand that I do not have rights to royalties or payment in any form for these materials, neither today or in the future.
Parent/ Guardian Name
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First
Last
Date
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I assume responsibility and waive any claim for compensation for injury incurred by my/our child(ren) while attending STEM NOLA's Saturday event and hereby agree to indemnify or hold harmless STEM NOLA and the STEM NOLA staff and professional volunteers against any and all claims, which may arise from an injury to my/our child(ren) while participating in the program.
Parent/ Guardian Name
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First
Last
Date
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