Project Pipeline 2023 Field Trip Registration Form

Project Pipeline Field Trip Registration

The fourth annual Project Pipeline Field Trip will be held Wednesday, July 31, 2024. Drop-off/departure will be at the Small Center for Collaborative Design, 1725 Baronne St., New Orleans, at 9 AM. Pick-up will be at the same location at 5 PM. Transportation will be provided to our field trip locations. Please contact us at (512) 922-6147 or info@nomala.org with any questions or concerns.
Parent/Guardian Info

If you are older than 18 (a college student or professional), you DO NOT have to fill out this section.
Primary Parent/Guardian Name*

First NameLast Name
Contact Email*
example@example.com
Phone (We will only contact you for an emergency)*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Field Trip Participant Info

High school students, college students and professionals (everyone), please fill out this section with the information of the person participating in the field trip. If you are registering multiple participants, please enter their information one at a time.
Participant Name*

First NameLast Name
Participant Gender*
Participant Race and Ethnicity*
Select any and all that apply.
Participant Email*
example@example.com
Participant School or Workplace*
Participant Age*
Participant Grade Level in Fall 2022*
(if participant is a high school or college student)
Participant Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Participant T-Shirt Size*
Participant Dietary Restrictions, if any
Have you participated in Project Pipeline summer camp or workshops before? If yes, what year(s)?*
Documentation

As a participant, or responsible parent/guardian of this participant, I hereby consent to the use of photographs/videos taken during the course of this activity for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my/my child's information for Project Pipeline program purposes.No, I do not give consent to use my/my child's information.
How did you hear about Project Pipeline?*
Should be Empty:

Project Pipeline Field Trip Registration

Parent/Guardian Info

Field Trip Participant Info