REGISTRATION FOR "Natural Disasters Engineering" ON 3/11/17 AT BALLARD ELEMENTARY



By registering your child for the EYE Saturday Program, you understand that photos and/or videos of your child(ren) may be used in post-event presentations, emails, on our website, etc. All photos are used internally, and are not sold or transferred to other groups. We apologize for any inconvenience.


Name of Child *
Name of Child
Date of Birth *
Date of Birth
Parent Name *
Parent Name
Address *
Parent Cell Phone *
Parent Cell Phone
Parent Home Phone *
Parent Home Phone
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
The EYE staff is American Red Cross CPR/AED/First Aid Certified
The EYE Saturday Program provides a free pizza lunch for all participants! To avoid wasting food, please check the appropriate box below. *