HaCkRz Registration 2020-2021

Student Name *

First and Last Name

Date of Birth *

Student Grade *

Bulldog Pathways 7th Bulldog Pathways 8 Bulldog Tech 7th Bulldog Tech 8th

Student E-mail

PARENT/GUARDIAN INFORMATION

Full Name *

First Name Last Name

Cell Phone # *

Area Code Phone Number

Parent/Guardian Email *

example@example.com

Cell Phone # *

Area Code Phone Number

EMERGENCY CONTACT INFORMATION: Other than Parent/Guardian

Full Name

First Name Last Name

Phone #

Area Code Phone Number

Relation

This program is provided in partnership by LeyVa Middle School, PEER Foundation, Silcon Valley Education Foundation and Wells Fargo. Students will work in teams throughout the year and will participate in a Hack-a-thon Showcase in March to present their ideas to a panel of judges. While there is no fee for the program, registration assumes full participation in the ENTIRE program (September 2020 - March 2021).

I hereby grant permission for my child to attend and participate in the HaCkRz program listed herein & agree to the Terms and Conditions set forth herein. I hereby release and discharge LeyVa Middle School, Evergreen Elementary School District, PEER Foundation and its employees, and contractors from and against all claims and losses of any type arising out of or relating to my child's participation in this program.

All ideas and content created by participants in the program are the property of PEER Foundation.

I am 18 years of age or older and the parent or legal guardian of the above-named child.

By checking this box, you agree to have read the terms and conditions of our policy