Registration Form
Tuesday, July 15, 2003
home program workshops science talk volunteer questions & answers contact us
Please print and then complete this form, include a check (for lunch and tee-shirt) made out to Stanford University, and return it to Lisa Mongetta, Bldg 041, Room 243 or send to MS 11 by June 27. You may call Lisa with your questions at x2733 or by email at mongetta@slac.stanford.edu. If you wish to schedule one child with another, and they are in the same age group, please include this information below under special requests. Space is limited; workshop assignment is accommodated on a first come first served basis.
Child Name: ___________________________ Age:__________
Workshop Choice (circle one): Age 9-11 years Option A Option B
Age 12-16 years Option C Option D
Special Requests:____________________________________________
Tee Shirt Size (circle one) Adult Sizes: S M L XL XXL ($2.00 extra)
SLAC Sponsor Name:_________________________ Relationship:__________________
Work Ext: _____________ Email address: _____________@slac.stanford.edu
Tee Shirt for sponsor (optional): _____Yes ______No
$5.00 each (circle one) Adult Sizes: S M L XL XXL ($2.00 extra)
Lunch for sponsor (optional): $5.00 _____Yes ______No
Costs Summary: Child (Lunch and Tee Shirt): $10 Adult Tee Shirt: $5 Adult Lunch: $5
Check made out to Stanford University Check Number:________ Check Total: $________
Please Check one can escort six kids from 9:00 to 2:30 _______
can escort six kids from 9:00 to 11:30 _______
can escort six kids from 12:30 to 2:30 _______
am unable to escort _______
Emergency Contact Name: _____________________ Phone: ________________
Parental Consent:
My child, ___________________, has my permission to participate in the “Kids Day @ SLAC” activities on July 15, 2003.
Signature__________________________ Date________________
Parent only
Teresa Troxel June 02, 2003