Please list any known health problems (Allergies, Diabetes, Asthma, Epilepsy, Heart trouble, etc) your child has.

Please list any dietary needs or restrictions for your child

In case of an emergency, consent is granted to the Staff of SEMAA and Morgan State University to provide medical services through the appropriate medical facilities and/or medical service providers to my child. Yes/No

Include Name

Phone number #1

Phone number #2

Include Name and Two Phone numbers

Please include First and Last Name and Relationship to Student

T-shirts are for sale. Please Choose appropriate and right size for student

Check all that apply

I ACKNOWLEDGE THAT I HAVE READ THE FAMILY CAFE NOTICE BELOW.FAMILY CAFÉ is the second core component of service of the NASA MUREP Program.  Parents, guardians, relatives and other supportive, adult role models of NASA BMAA/SEMAA students are required to participate. The Family Café is an interactive forum that provides STEM education and parenting information to any supportive, adult role models that the student might have. The Family Café also puts the adult in touch with other local resources and STEM programs that are available for their student.  Typically, the Family Café meets for 3-hour sessions on pre-drtermined Saturdays during the current MUREP session.  Parents are required to participate in no less than 5 sessions.

I, the parent/guardian of the above student, do hereby release and discharge National Aeronautics and Space Administration (NASA), the National MUREP Office, this MUREP site (BMAASEMAA), Morgan State University, members, administrators and agents from any and all claims, present and future, known and unknown, due to, or arising in any manner from, my child's participation in the project or related activities sponsored by MUREP.  I have read or someone from the MUREP project has read and explained the information contained in this form to me. I willingly agree and give consent to let MUREP enter data about my child and me into its computer information system.  I hereby grant the National Auronautics and Space Administration (NASA) and others acting on its behalf, the right to record me and my child and our voice using audio, photographic, video or other such techniques; to include mine and my child's name, likeness, voice and biographical material in connection with these recordings; to use, reproduce, distribute and exhibit such recordings in any and all media throughout the world without limitation; and to authorize others to do so, for any purpose which NASAand those acting pursuant to its authority, deem appropriate.  I hereby waive all righs of any nature in such recording(s) and the exhibition thereof. It is understood that this grant is provided at no cost to the Government and that no compensation of any knid shall be due or expected.  In case of an emergency, consent is granted to the staff of BMAA to provide medical services through the appropriate medical facilities and/or medical service providers to my child. PLEASE WRITE YOUR NAME AS SIGNATURE