Kids Day @ SLAC 2004

Thursday, August 19, 2004

Registration Form (one form per child)

 [Back to Kids Day @ SLAC 2004 Home Page]

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 9:00 to 2:30   ______   Can escort kids from 9:00 to 11:30 _____

                   Can escort kids from 12:30 to 2:30 ______ 

Drivers:        Can transport in SLAC Van 9:00 to 2:30    ______

            Can transport in SLAC Van 9:00 to 11:30 ______

                    Can transport in SLAC Van 12:30 to 2:30         _______

SLAC Emergency Contact Name: _____________________    Phone: ________________

Parental Consent:

My child, ___________________________, has my permission to participate in the “Kids Day @ SLAC” activities on August 19, 2004 . I understand closed toed, no heeled shoes are required. 

 

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