Eco-Adventures: STEM & Green Engineering Series Registration Form

Eco-Adventures: STEM & Green Engineering Series Registration Form
The Eco-Adventures: STEM & Green Engineering Series is a weekend STEM program, that will take place on four Saturdays this fall. This series is designed to engage youth in hands-on, sustainability-focused engineering challenges.

Each session introduces real-world environmental challenges and allows young people to design, build, and test solutions using STEM concepts. Participants will also get to meet and chat with experts in the field!

Sessions will take place from 10 am to 12 noon at the Camden County Library Voorhees branch.

Programming is free of charge and made possible with a Sustainable South Jersey Mini-Grant.

REGISTRATION IS OPEN FOR:
🏙️ 12/20: Sustainable Cities Challenge: Design and create an eco-friendly city using recycled materials!
Session Selection
Select which session(s) you would like to register your child for:

🏙️ 12/20: Sustainable Cities Challenge
Participant Information
Participant Name*

First NameLast Name
Participant Age*
Does your child have any allergies or medical concerns?
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian E-mail*
example@example.com
Parent/Guardian Phone Number*
Emergency Contact Information

(in case the Parent/Guardian above cannot be reached)
Emergency Contact Name*

First NameLast Name
Relationship to Participant*
Emergency Contact Phone Number*
Please enter a valid phone number.
Liability Waiver & Photo Release
Waiver and Release of Liability

By completing this registraion, I, the above-named parent or legal guardian of the above-named participant, acknowledge and agree to the following terms in consideration of my child’s participation in the Eco-Adventures: STEM & Green Engineering Series, hosted by Future Leaders STEM Lab (FLSL):
1. Assumption of Risk: I understand that participation in hands-on STEM activities, including but not limited to building, engineering, and outdoor experiments, involves inherent risks, including but not limited to minor cuts, burns, allergic reactions, or other injuries. I voluntarily assume all risks associated with my child’s participation in this program.
2. Release of Liability: I agree to release, waive, discharge, and hold harmless Future Leaders STEM Lab (FLSL), its venues, directors, instructors, volunteers, and affiliates from any and all claims, liabilities, damages, or injuries, whether caused by negligence or otherwise, arising from my child’s participation in the program.
3. Medical Authorization: In the event of an emergency where I cannot be reached, I authorize FLSL staff to administer first aid or seek medical treatment for my child as necessary. I understand that I am responsible for any medical expenses incurred.
4. Code of Conduct: I acknowledge that my child is expected to follow all safety guidelines and behavior expectations during the program. Repeated failure to follow instructions may result in dismissal from the program.
5. Acknowledgment & Signature: I have carefully read and fully understand this Waiver and Release of Liability. I voluntarily agree to the terms stated above and confirm that I am legally authorized to sign on behalf of my child.
Acknowledgement of Waiver and Release of Liability*

By checking this box and completing this registration form, I acknowledge and agree to the terms outlined in the above "Waiver and Release of Liability"
Photo Release

Check this box only if you do NOT want photos of your child taken. Unless this box is checked, I consent to my child being photographed for promotional materials (social media, website, flyers, etc.).
Should be Empty:

Eco-Adventures: STEM & Green Engineering Series Registration Form

Session Selection

Participant Information

Parent/Guardian Information

Emergency Contact Information

Liability Waiver & Photo Release