Mother & Daughter Engineering Event Registration

Mother & Daughter Engineering Event

Registration Form
Saturday April 18,2020
6:00-8:00
Stepping Stones Museum

Investment: $25 per mother/daughter team $5 per female sibling
Child's Name

First Name Last Name
Birth Date

Month Day Year
Parent

First Name Last Name
Child's Age
Grade

Home Address

Home Phone Number

Area Code Phone Number
Work Phone Number

Area Code Phone Number
Email
example@example.com
Cell Phone Number

Area Code Phone Number
Emergency Contact

First Name Last Name
Emergency Phone Number

Area Code Phone Number
Voice, Likeness, Comments Release: I give my permission to Stepping Stones Museum and Saturday Academy Inc to use photographic images taken or likeness taken of my child in college publications, displays, marketing materials and website pages. I understand my child’s image may also be used in press releases and sent to news publications and other forms of print and digital media. I fully understand the intent of using my child’s likeness and /or comments, and in doing so do hereby relinquish any responsibility on the part of Stepping Stones Museum and Saturday Academy Inc.
Parent Signature

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Today's Date

Month Day Year
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Order Online by checking the box

Mother & Daughter Engineering Event $ 25.00

Mother & Daughter Engineering Event - Additional Girl (s) $ 5.00

Quantity

Total $ 0.00
If paying by check or money order mail to Saturday Academy . P.O. Box 702, Norwalk, CT 06854 ATT: Dr. Cynthia Barnett

QUESTIONS? Call Dr. Cynthia Barnett 203-855-9714
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