[OLD] Sign Up Beta

Thank you for your interest in our workshops! Sign-ups are currently open for our Summer 2019 workshops — there's just a few more steps to register.

Sign Up Form

Time: 3:00-5:00pm.
Venue: Omei Academy, Cupertino, CA.
Donation: $30/day to cover for materials.
Please donate via PayPal to [email protected] as soon as you sign up to guarantee your space.

* Indicates required field

What is your email? *

Which workshops would you like to sign up for? *

August 4th: Java Programming & Artificial Intelligence August 11th: Natural Selection & Physics

Student Information

Student Name *

First

Last

Student Grade *

Student School *

Phone Number *

Necessary Medical Accommodations (allergies and sensitives, including airborne/skin contact and whether your child carries an epipen, and any other conditions or special circumstances we should be aware of) * *

Additional Comments *

Legal Releases

My son/daughter(s), has my permission to participate in the STEMBoost Summer STEM Workshops of 2019 at Omei Academy. I hereby agree to hold harmless the STEMBoost Board of Directors, officers, instructors, volunteers and Kennedy Middle School and staff and/or their members with respect to any and all damages or expenses which may be incurred, suffered or required to be paid by reason of this activity before, during or after each workshop. In addition, I hereby authorize STEMBoost to use, modify, reproduce, distribute photograph/videotape of my child for publicity and promotional purposes. *

I Agree

In the event of illness or injury, I consent to all routine and/or emergency medical treatments and/or services prescribed by the attending doctor, surgeon, dentist or other health care provider and to the administration and performance of all examinations, treatments, anesthetics, operations, and other procedures which are deemed necessary or advisable by the attending doctor at the scene and/or at the hospital or other medical facility. Above are my child's medical information and statements, and the telephone number where I can be reached during the workshop(s), should it be necessary to contact me in the event of an emergency. *

I Agree

Parent Information

Parent Name *

First

Last

Parent Signature *

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Student Information

Legal Releases

Parent Information

Please feel free to send us an email if you are interested in joining us.