Mother & Daughter Engineering Event Registration

Mother & Daughter Engineering Fest

Registration Form
Awesome event for girls in 3rd-8th grade
Siblings must be in the 3rd-4th grade

Saturday April 16, 2022
10:00am - 2:00pm
George Washington Carver Community Center
7 Academy St, Norwalk, CT 06850

All participants must be vaccinated
Wear face coverings
PIzza lunch included

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

First NameLast Name
Birth Date

MonthDayYear
Parent

First NameLast Name
Child's Age
Grade
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Work Phone Number

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

Area CodePhone Number
Emergency Contact

First NameLast Name
Emergency Phone Number

Area CodePhone Number
Voice, Likeness, Comments Release: I give my permission to George Washington Carver Community Center 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 George Washington Carver Community Center and Saturday Academy Inc.
Parent Signature

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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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Mother & Daughter Engineering Fest