Bring Our Kids to SLAC Day - August 1, 2002

Registration Form

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Print this form and fill out COMPLETELY! Return completed form to Lisa Mongetta, MS 11, by  Friday, July 26. You may contact her by phone at  x2733 or by email at mongetta@slac.stanford.edu if you have questions. If you wish to schedule one child with  another (must be same age group) please include this information below under special  requests. Workshop assignment is based on a first come, first serve basis. Space is limited.

CHILD

name:                                                                                age (9-16):

workshop choice (circle one)            age 9 - 11 yrs:   Option A   Option B

                                                    age 12 - 16 yrs:    Option C    Option D

special needs or requests:

SLAC SPONSOR

name:                                                                                        relationship:

e-mail address:                        @slac.stanford.edu                        work extension #:

please circle:    unable to volunteer

                        can escort 6 kids from 9:15 to 11:30

                        can escort 6 kids from 12:45 to 3:00am 

EMERGENCY CONTACT

name:                                                        phone #:

Mandatory Consent Form - Signed By PARENT ONLY

My child, _______________________, has my permission to participate in "Bring Our Kids to SLAC Day" activities at SLAC on August 1, 2002.

Signature ___________________________ Date ____________

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Teresa Troxel July 09, 2002