ULL Tech Lab Registration Form

STUDENT INFORMATION:

Welcome to Tech Lab! Please provide the following information. All youth ages 5-19 require adult consent. If you have a group of 50 or more students, please go back to the registration section on our website and click where designated. Otherwise, please proceed in completing the short, individual registration form below.
STUDENT NAME: *

First Name Last Name
REGISTERING FOR: *

Online Coding Academy (Ages 5-19) LEGO Robotics (Pre-Registration Only, Ages 5-13)
GRADE LEVEL: *
BIRTH DATE: *

Month Day Year
PHONE NUMBER:

Area Code Phone Number
EMAIL ADDRESS:
CITY/STATE: *

Street Address

Street Address Line 2

City State
SCHOOL, INSTITUTION, OR GROUP AFFILIATION: *
PARENTAL OR INSTRUCTOR CONSENT:

Thank you for registering your child our student our online program. While parents, teachers, mentors, and counselors are welcome to use our free course as an introductory educational resource, all youth 18 and under require adult consent.
PARENT NAME: *

First Name Last Name
PARENT PHONE NUMBER: *

Area Code Phone Number
PARENT EMAIL ADDRESS: *
Parental Consent Document:
Please click here to view our parental consent document.
CONSENT CONFIRMATION: *

I confirm that I have read & agree to the terms of the consent document.
EMERGING ENTREPRENEURS, INC.
A registered 501(c)(3) non-profit organization
Tax ID: 27-3539188
Office: 4819 Emperor Blvd., Ste. 400 Durham, NC 27703
Mailing: PO Box 13022 Durham, NC 27709
919) 886-4711
info@emerginginc.org
www.emerginginc.org

—Tax Deductibility & Organizational Exemptions:
eMerging Entrepreneurs, Inc. is an exempt organization under section 501(c)(3) of the Internal Revenue Code; and is classified as a Public Charity under section: 170(b) (1) (A) (vi). Contributions made to eMerging Entrepreneurs, Inc. are deductible under section 170 of the Code. eMerging Entrepreneurs, Inc. has also received a gold rating from the Guidestar Exchange for our commitment to organizational transparency. Please feel free to contact us if your organization requires a copy of the charity’s Letter of Determination, or confirmations filed IRS for proof of registration with the IRS. We have also provided the following confirmations, as provided by the NC Dept. of the Secretary of State, and US Internal Revenue Services:

» IRS Tax Status Form 990-N (ePostcard) Filings.
» Guidestar.com Transparency Report (Platinum Seal).
» NC Sec. of State Business Registration Filing.
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STUDENT INFORMATION:

PARENTAL OR INSTRUCTOR CONSENT: