Please print and complete this form, include a check (for lunch and tee-shirt) made out to Stanford University, and return to Maria Herraez, Bldg 041, Room 204G or send to MS:01 by July 31. You may call Maria with your questions at x4336 or by email at herraez@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’s Name: ___________________________ Age:__________

Workshop Choice (circle one):  Age 9-11 years Option:  A   B   C   Age 12-16 years Option:  D   E   F

Special Requests: _________________________________________________________________________

T-Shirt Size (circle one)  Adult Sizes:  S  M  L  XL  XXL  ($2.00 extra). There are no exchanges or refunds.

TOTAL FOR CHILD ($13 or $15 if choosing XXL)                                                                     A. $ ______

SLAC Sponsor Name: __________________________________       Relationship: ___________________

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

T-Shirt for sponsor (optional): $7.50 each (circle one) Adult Sizes: S M L XL XXL ($2.00 extra) B. $ ______

Lunch for sponsor (optional): $5.50 _____Yes ______No                                                       C. $ ______

Make check out to Stanford University   Check No.:________                   Check Total (A, B, &C): $ ______

Costs Summary: Child (Lunch and Tee Shirt): $13/$15, Adult Tee Shirt: $7.50/$9.50; Adult Lunch: $5.50

We would love to have you assist with the day (and have fun with your Kids!)

Escorts: Can escort kids from (check one):

9:00 to 2:30 ______ 9:00 to 11:30 ______ 12:30 to 2:30 ______

Drivers: Can transport in SLAC Van (check one):

9:00 to 2:30 ______ 9:00 to 11:30 ______ 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 16, 2006. 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

Parent Signature:__________________________ Date:__________ Daytime Phone: _____________

SLAC Home Page  Teresa Troxel  July 03, 2006