STEAM ASTRO Event (NASA Day) - Event registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

STEAM ASTRO Event (NASA Day) - Event registration - Natchitoches

Event Address: NSU campus, exact location will be emailed to registered participants
Contact us at steminfos@gmail.com or engineering@nsula.edu

Email *

Option 1

Clear selection

Student Name: *

Home address including State/Country *

Parent/Guardian name: *

Parent’s/Guardian’s email address: *

Gender: *

Male

Female

Other:

Ethnicity: *

White

African American

Native American

Hispanic

Asian Pacific Island

Other:

Grade level *

Other:

What event will you attend? *

NASA day, Friday, June 10, 9:00 AM-12:00 Noon

Required

Media Release

I am the parent/guardian/legal representative of the student above and do hereby give permission for the above-named minor child (hereinafter "Minor") to be photographed and/or videotaped by NASA, STEM Pioneers, NSU or their representatives. I understand and agree that the photographs and/or videotapes containing the image and/or voice of the Minor may be used in the production of instructional and/or promotional materials produced by or on behalf of NASA, STEM Pioneers, or NSU (hereinafter the "Program") and that such materials may be distributed or broadcast to the public and displayed publicly. I also understand that my permission to use the photographs and videotapes is for an unlimited duration and that neither I nor the Minor will receive any compensation for granting this permission or for the use, if any, by NASA, STEM Pioneers, or NSU of the Minor's image and/or voice.

I acknowledge that NASA, STEM Pioneers, or NSU has no obligation to use the Minor's image or voice in connection with the Program.

I hereby unconditionally release NASA, STEM Pioneers, or NSU and their representatives from any and all claims and demands arising out of the activities authorized under the terms of this agreement.

By providing my name here, I confirm that I am at least 18 years of age and am the parent/guardian/legal representative of the above-named Minor. I have read the foregoing agreement and am familiar with all of the terms and conditions thereof and I consent to its execution by the Minor. I agree that neither I nor the Minor will revoke or disaffirm this agreement at any time.

Organizations
NASA: National Aeronautics and Space Administration
NSU: Northwestern State University of Louisiana
STEM Pioneers

I have read the media release information and I agree with all its contents *

Yes

I have read the media release information above and I agree with all its contents: (Print your name) *

Emergency contact and relation: *

Emergency phone number : *

Would you like to be added to our contact list? *

Yes

I understand that the program will NOT provide any sort of transportation from or to the event. Parents are responsible for their children's transportation. *

Yes

Please list any other information you’d like to include about your camper (None if not applicable) *

I understand that the camp is FREE and my child will follow all the instructions, and complete all the activities, otherwise, they may be dismissed *

Yes

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms