Summer of STEM Registration Form

Summer of STEM Registration Form

Rev Up Your Summer at the Studebaker National Museum! Join The Riverbend Community Math Center and the Museum for a 4-day Summer of STEM Workshop filled with creativity, innovation, and fun from June 10-13! Perfect for young car enthusiasts and budding inventors, this hands-on program runs from 9:00 AM to 12:30 PM each day and offers an unforgettable experience that blends history, technology, and design. Workshop Highlights include: Designing and building your own 3D-printed car, learning how iconic cars came to be and the role of Studebaker in shaping the industry. Spots are limited; register now to guarantee your place! Programming is intended for children ages 10-14.
Child Information
Child's Name

First NameLast Name
Age
MaleFemaleOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
YesNo
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Studebaker National Museum and The Riverbend Community Math Center during the workshop. In exchange for the acceptance of said child’s candidacy by both The Studebaker National Museum and The Riverbend Community Math Center, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Studebaker National Museum and The Riverbend Community Math Center and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected workshop sessions.

In case of injury to said child, I hereby waive all claims against The Studebaker National Museum and The Riverbend Community Math Center including all workshop supervisors and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

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Date
Signature

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Payment Information
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1 Workshop Registration
Summer of STEM: June 10-13, 9am-12:30pm each day.

$150.00

Total

$0.00

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Summer of STEM Registration Form

Child Information