Mother, Grandmother & Daughter Biomimicry Event Registration Form

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An opportunity for girls in the 2nd to 7th grade to spend the morning with their mom, grandmother or mentor to tackle science and engineering design challenges!
Space is limited, so please make sure you are able to attend. The Event is on November 19th from 10:00am to 12:00pm at The Carver on 7 Academy Street, Norwalk. Lunch will be served. Please plan to arrive by 9:45. We start promptly at 10:00.

Email *

Is your child currently enrolled in The Carver After School Program at your school?
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Yes

No, skip the next question

If yes, which program?

After The Bell AM/PM

After The Bell AM only

After The Bell PM only

5th Grade Scholar Program

After School Program in the Middle Schools

Other:

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Child's Name
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Child's Birth Day
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Child's Age
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Child's School
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Grade Attending
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Parent's Name
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Address with City, State and Zip
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Cell Number
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Emergency Contact and cell number
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PHOTOGRAPH/VIDEO RELEASE In connection with Saturday Academy Inc. and/or its Amazing Girls Science program (collectively “Saturday Academy”) activities, I understand photographs and/or videos may be taken that include my child(ren) and/or me and our participation and/or work product from such activities. I hereby consent to the use by Saturday Academy Inc. and its respective affiliates, successors, agents, employees and assigns, of any photographs and/or videos that have been or will be taken on behalf of Saturday Academy. I hereby grant to Saturday Academy all right, title and interest that I or my children have or may acquire in such photographs and/or videos including the right to use, reuse, publish and republish them, in whole or in part, for any purpose whatsoever, in any and all media, print and electronic formats. I understand that I and my children will not receive any compensation in connection with such photographs and/or videos or the rights granted above. I hereby release and discharge Saturday Academy from any and all claims and demands arising out of or in connection with the use of such photographs or videos. I represent that I have the legal right to sign on behalf of the child or children below and have read and understood this document and have freely signed below.
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Yes, I give permission

No, I do not give permission

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