Science Olympics for Girls - October 21, 2023

Is Science the Name of Your Game? Inviting 5th-8th Grade Girls to Explore the Possibilities at Lauralton Hall!

Participant First Name required

Participant Last Name required

Street Addressrequired

City required

State required

Zip Coderequired

School required

Graderequired

I wish to participate:required

by myself

on a team

Names of other students you would like to be teamed with (or say "assign me to a team")

Parents, will you be staying for the Parent Program/Open House?required

Yes, I will be staying to attend the Parent Program/Open House.

No, I am unable to stay for the Parent Program/Open House.

Parent Email Addressrequired

Parent Phone Numberrequired

(XXX) XXX-XXXX

PERMISSION AND RELEASE

I give permission for my child to attend the Science Olympics and, in consideration of my child’s participation. I hereby release the Academy of Our Lady of Mercy, Lauralton Hall and its agents from any claim, liability, damage, or loss of any type whatsoever which may arise in connection with this activity/program. In doing so I acknowledge my authority to sign this release. I understand that from time to time the school may use photographs/video recordings of participants in the Science Olympics for public relations interest stories, athletic articles, news, and other marketing of Lauralton Hall in the newspaper, on television, and on the website. I give permission for such photographs of my child to be used for marketing purposes.

I authorize Lauralton Hall to obtain medical treatment for my child in an emergency or to take any other necessary actions for my child’s safety and well-being. I release and agree to indemnify Lauralton Hall from any liability to any person arising out of good faith decisions made by Lauralton Hall pursuant to the provisions of this paragraph.

Print Parent/Guardian Name below to accept.

EMERGENCY INFORMATION

Emergency contact first and last name required

Emergency contact relation to student required

Emergency contact phone number required

Does your child have allergies or other medical concerns? required

Yes

Specify allergy or medical concerns required

My daughter has my permission to self-administer medication (insulin, epi-pen)required

Yes

Specify type of self-administered medication required

Parent authorizing first and last name required

Choose all that apply.

If Word-of-Mouth, can you let us know who told you so we can thank them?

If Other, please specify: