High School Science Saturday

Student Information

First Name

Last Name

Email Address

Mobile Phone

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Gender

Female

Male

Other

Prefer not to answer

Education

I'm currently a student at:

What grade are you in and what year would you start college?

Have you imagined a career direction? In other words: "What do you want to be when you grown up?"

What scientific field most interests you?

Parent/Guardian Information

Relationship Type:

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone

Parent/Guardian Email

Does your child qualify for the National School Lunch Free or Reduced –Priced Lunch Program?

Yes

No

Are you a member of the Stetson community? (Faculty, Staff or Student)

Yes

No

Please enter your Stetson ID Number (#800):

Emergency Contact Information

Contact Name:

Contact Phone Number:

Registration Confirmation:

I understand a balance of $50 will be due at least two weeks prior to the start of the program.

Yes

You may bring your own lunch or you have the option of a provided boxed lunch OR dining in the Stetson Commons (if it is open). Please let us know your preference.

Yes, I would like a boxed lunch/or to eat lunch in the cafeteria.

No, I will bring my own packed lunch.

If you have selected the boxed lunch/eat lunch at the cafeteria option, please tell us any dietary needs:

Specific Dietary Restrictions:

I have read and agreed with the Stetson Liability and Risk Acknowledgement and the Emergency Medical Treatment Consent and I will sign and submit these forms either on-line, via email, or in person before the program begins.

Yes

Upload your signed and scanned Stetson Liability and Risk Acknowledgement here, download, sign, scan and email the form to young-scholars@stetson.edu.

Upload your signed Emergency Medical Treatment Consent here.

Signature Required: