Kids Day @ SLAC 2004
Registration Form (one form
per child)
Please
print and 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 August
12. 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 request 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
Option C
Age
12-16 years: Option D Option E
Option F
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:
Escorts:
Can escort kids from
Can escort kids from
Drivers:
Can transport in SLAC Van
Can transport in SLAC Van
Can transport in SLAC Van
SLAC
Emergency Contact Name: _____________________
Phone: ________________
Parental
Consent:
My child,
___________________________, has my permission to participate in the “Kids
Day @ SLAC” activities on
I give permission for SLAC to
utilize photographic images and/or the name of my child for SLAC Kids Day
promotional pieces, announcements, website, etc.
_____Yes _____No
Signature__________________________
Date__________ Daytime Phone:_______________
Parent
only