BioSpark Middle School - Workshop Registration Form

BioSpark Middle School - Workshop Registration Form

Fill out the form carefully for registration
Student Name*

First NameLast Name
Student Email*
example@example.com
Student Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address (if different from Attendee)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current School Attending*
School District
Grade Level*

Grade 6Grade 7Grade 8
Biology Teacher's Name*

First NameLast Name
Biology Teacher's Email*
example@example.com
Have you participated in any of the following activities? (Check all that apply)*

Science fairsSTEM clubsSummer science campsResearch internshipsNo prior activitiesOther
School and Community Activities/Leadership Positions
List any science-related awards, certifications, or achievements
How did You learn about Workshop?*

Friends & FamilySchool Bulletin Board/NotificationReferred by another applicantOther

My Products*

Registration Fees

$199.00 Quantity

Registration Fees (By Invitation Only)

$149.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

ALAMO BIOCENTER BIOTECH BOOTCAMP LIABILITY WAIVER
WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, the undersigned participant (or parent/legal guardian of the participant if under 18), acknowledge that participation in the BioSpark Biotech Bootcamp at Alamo BioCenter involves hands-on laboratory activities, including but not limited to working with biological materials, laboratory equipment, and chemicals. I understand that participation in these activities carries inherent risks, including but not limited to exposure to laboratory reagents, accidental injury, or unforeseen hazards associated with a working lab environment.*

Agree
ASSUMPTION OF RISK I voluntarily assume full responsibility for any risks of injury, illness, damage, or loss that may result from participation in this program. I acknowledge that Alamo BioCenter follows safety guidelines and protocols to minimize risks, but I accept that complete elimination of risks is not possible.*

Agree
WAIVER AND RELEASE OF LIABILITY I hereby release, waive, discharge, and hold harmless Alamo BioCenter, its directors, employees, mentors, instructors, and affiliates from any and all liability, claims, demands, or causes of action arising out of or related to any loss, injury, illness, or damage that may occur during or as a result of my/my child’s participation in the BioSpark Biotech Bootcamp, whether caused by negligence or otherwise.*

Agree
MEDICAL AUTHORIZATION In the event of an emergency, I authorize Alamo BioCenter staff to seek medical treatment for me/my child, including transportation to a medical facility if deemed necessary. I understand that I am responsible for any medical expenses incurred.*

Agree
CODE OF CONDUCT I acknowledge that all participants are expected to adhere to the program’s safety protocols and behavioral guidelines. Any participant who fails to follow instructions or engages in unsafe or disruptive behavior may be dismissed from the program without refund.*

Agree
PHOTO/VIDEO RELEASE (Optional) I grant permission for Alamo BioCenter to use photographs and/or video recordings of me/my child taken during the program for promotional, educational, and informational purposes.

Yes, I grant permissionNo, I do not grant permission
ACKNOWLEDGMENT AND e-SIGNATURE By signing below, I confirm that I have read and fully understand this liability waiver. I voluntarily agree to the terms outlined above by printing my name on this form below:*
Parent/Guardian Signature (if under 18 else type NA):*
Today's Date and Date of signing this Form:*

MonthDayYear
Date
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BioSpark Middle School - Workshop Registration Form

ALAMO BIOCENTER BIOTECH BOOTCAMP LIABILITY WAIVER