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Science Alive

Registration

Registration is closed!


Student Registration Form

Fill out one form for each student attending.

Name of Child:
Address:
City:
State:
Zip code:
Phone:
Emergency Phone:
E-mail:
School District:
School:
Birthdate:
Grade:
Gender: Male     Female

If you have special needs, please let us know how we can assist you during the conference.

I will use free bus pickup (Hollister only): Yes     No

Student Workshop Choices:

Click here to see a complete list of workshop choices for students.

Select four. You will be assigned three. We will make our best effort to assign you to workshops of topics you indicate. Remember that with more than 300 participants attending the conference, we cannot accommodate everyone's specific choices

Due to workshop space, registration may close before the deadline.

1st Choice:
2nd Choice:
3rd Choice:
4th Choice :

Authorization for Emergency Medical Care:

In case of an emergency, I grant permission for my child to receive emergency medical care while attending the 2014 Science Alive Conference at Gavilan College. Yes      No

Registration:

Fee Waiver - My child participates in a free or subsidized meal program
or ...
Pay Registration - Registration Fee is $10.00 for each parent/child

Number of attendees:    x $10.00 = $
Method of Payment: Cash      Check      Fee Waiver

Make checks payable to Gavilan College. Please send your check or money order to:

Gavilan College Science Alive
5055 Santa Teresa Blvd.
Gilroy, CA 95020

Registration fees must be received by
Friday January 31, 2014 by 5:00 p.m.


Student and Parent Responsibility:

Students attending this conference are responsible for following instructions and directions provided by staff, signs and campus guides. You must also attend all workshops you have registered for. Students must remain in designated areas for safety reasons. Parents of students unwilling to cooperate will be contacted and asked to pick up their child/children. A photographer may take pictures of you or your child. These photos may appear on our web site or in publications. If you register your child, you have given us permission to use their photos.

Refund Policy:

The deadline to request refunds is January 31, 2014 by 5:00 p.m. Contact by phone or e-mail. No refunds will be provided for parents of students who do not attend and who have not applied for a refund.

Hollister bus pickup location:

Maguerite Maze Middle School. Students should report by 7:30 a.m.





* * * Submit one registration form for each child * * *

Math and Science can be fun!

Last modified: January 22, 2014
Gavilan College Red Diamond 5055 Santa Teresa Boulevard Red Diamond Gilroy, CA 95020 Red Diamond (408) 848-4800