Registration Is Closed for May 10th

Name of Child

First Name

Last Name

Parent Email

Date of Birth

YYYY

School

Grade

Parent Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Cell Phone

(###)

###

####

Parent Home Phone

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone Number

(###)

###

####

Known Allergies

Other Health Conditions

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.

YES, my child will be eating a pizza lunch

My child will be bringing a bagged lunch

Pictures

Yes, I grant permission for my child to be photographed during the school Educating Young Engineers event. I understand that these photos will be used for Educating Young Engineers purposes only (e.g, yearbook, school website, internal communications) and will not be sold.