Student Registration

Name

School Grade Level

Home Phone Number (please include your area code) () -

Email address @

Emergency Contact

Emergency Contact Phone Number () -

Emergency Contact Relation

Boxed Lunch (please specify which type of boxed lunch you would prefer)

Normal Vegetarian Vegan None

Username of your Chaperone

Session Topics: Please pick five sessions that you would like to attend in order from most prefered to least prefered.
Click here to see a description of the session topics.

Session Topic # 1:

Session Topic # 2:

Session Topic # 3:

Session Topic # 4:

Session Topic # 5:

Session Preference(s) within your chosen topics:
(Enter "NONE" if you have no preference.)



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