Registration Form

(one 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 Michelle Steger, Bldg 120, Room 219 or send to MS 99 by July 22.  You may call Michelle with your questions at x3011 or by email at steger@ 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 extra)

SLAC Sponsor Name:_________________________     Relationship:__________________

Work Ext: _____________   Email address: _____________@slac.stanford.edu

Tee Shirt for sponsor (optional):  _____Yes     ______No

$6 each (circle one) Adult Sizes:   S     M     L    XL    XXL ($2.00 extra)

Lunch for sponsor (optional): $6  _____Yes    ______No

Costs Summary: Child (Lunch and Tee Shirt): $12    Adult Tee Shirt: $6    Adult Lunch: $6

Check made out to Stanford University    Check Number:________ Check Total: $________

If you are able to help as a volunteer, 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 10, 2005. I understand closed toed, no heeled shoes and long pants are required attire for every child. I have reviewed all Safety Procedures with my child. 

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

$6.00