"Music in Engineering" - Ballard Road Elementary 1/16/16

Name of Child *
Name of Child
Date of Birth *
Date of Birth
Address
Address
Parent Name *
Parent Name
Parent Cell Phone Number *
Parent Cell Phone Number
Parent Home Phone Number *
Parent Home Phone Number
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone Number *
Emergency Contact Phone Number
The EYE Staff is American Red Cross CPR/AED/First Aide Certified.
The EYE Saturday Program provides a free pizza lunch for all participants! To avoid wasting food, please check the appropriate box below. *
Photo Release Consent *
I give consent for photos of my child taken at the EYE Saturday Program to be used in the promotion of further elementary engineering programs in Saratoga Springs.
Is your family eligible for financial assistance? *
If paying for EYES is a hardship please check the appropriate box below and we will waive the entrance fee.