Girls in STEM Summer 2026 Registration Form

AUTHORIZED PICK UP PERSONS

Please specify each person (including parents/caretakers) who has permission to pick up your student. Students will only be released to the persons listed below. If you need to make changes to your pick-up list, please email dmackey@fwmsh.org.
Authorized Pick Up Person #1*

First NameLast Name
Pick Up #1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pick Up Person #2

First NameLast Name
Pick Up #2 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pick Up Person #3

First NameLast Name
Pick Up Person #3 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pick Up Person #4

First NameLast Name
Authorized Pick Up Person #4 Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

PARENT/GUARDIAN ACKNOWLEDGMENT
STATEMENT OF POLICY
- A Registration Form is required for all participants.
- Parents/Caregivers are responsible for transporting their students to and picking them up from the Fort Worth Museum of Science and History.
- Each session begins at 9:00 AM and ends promptly at 3:00 PM.
- The Fort Worth Museum of Science and History reserves the right to deny
  participation to students who exhibit persistent behaviors that endanger themselves or others or disrupt the learning environment.
- If a participant becomes ill during class, the parent/guardian will be notified to pick up the student.
- Photos or videos of participants may be taken for archival and/or promotional purposes by the Fort Worth Museum of Science and History. No identification of participants will be used.
- Students must bring a lunch, a water bottle, and a snack to class each day.
- If students bring a cell phone, they must place it in a secure location in the classroom for the duration of the class day.
- Students are expected to dress in a safe manner that provides personal comfort/coverage and not disrupt the educational environment.
- The program is limited to the number of participants per class. Registrations will be reviewed in the order in which they are received.
- While we understand that illness and unforeseen circumstances can arise, this program depends on relationship-building among the girls, and lessons build on each other from day to day. By registering, you are committing to attend each day.
- I authorize the individuals submitted on the enrollment form to pick up my child from Girls in STEM. I understand I must email dmackey@fwmsh.org to make changes to my child's authorized pick-up list.
- I authorize the Fort Worth Museum of Science and History to secure any necessary emergency medical treatment and transport for my child to Cook Children's Medical Center located at 801 7th Ave, Fort Worth, TX 76104 in the event of a medical emergency.
- All medication information is correct and will be updated with the office as necessary.
- By clicking "I agree," I understand that participation in this activity/event is purely voluntary without compensation to my minor participant and that all material and images or other media will be used solely by Project Scientist and Fort Worth Museum of Science and History. If you choose to change your response at any time, please contact dmackey@fwmsh.org
agree
Parent/Guardian Signature*

Clear
Parent/Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date
Should be Empty:

SUMMER GIRLS IN STEM REGISTRATION FORM

CAMP SELECTION

STUDENT INFORMATION

FAMILY CONTACT INFORMATION

AUTHORIZED PICK UP PERSONS

PARENT/GUARDIAN ACKNOWLEDGMENT