Clone of Project Pipeline 2025 Registration

2026 Registration Form

These forms are required for your child to attend NOMA Connecticut Project Pipeline, in partnership with My Architecture Workshops Inc.

This one-week program will take place August 10–14, 2026, at Yale School of Architecture, 180 York Street, New Haven, CT 06511.
Camper Name*
Age*
Gender*
Date of Birth*
mm/dd/yyyy
Current Grade in 2026*
School Camper Attends*
T-Shirt Size*
How did you hear about us?

Social MediaSearch Engine (Google, Yahoo, ect.)ReferralOther
Date of Birth
mm/dd/yyyy
Current Grade in 2025
School Camper Attends
T-Shirt Size
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
example@example.com
Cell Phone*
Format: (000) 000-0000.
Home Phone*
Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work Name*
Or enter N/A if not applicable
Parent's Work Phone*
Format: (000) 000-0000.
Parent's Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would you like to be reached while your child is at camp?*

Cell PhoneWork PhoneHome Phone
Add second Parent/ Guardian Information?*

YesNo
Parents' Information

Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Work Name
Or enter N/A if not applicable
Parent's Work Phone
Format: (000) 000-0000.
Parent's Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contacts/Authorized Pickup

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Emergency Contact #1
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Format: (000) 000-0000.
Relationship to Child*
Authorized Pick Up?*

YesNo
Add Additional Emergency Contact?*

YesNo
Emergency Contact #2
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Format: (000) 000-0000.
Relationship to Child
Authorized Pick Up?

YesNo
Medical / Health Information
Name of Physician or Clinic/Hospital*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Format: (000) 000-0000.
Is the Camper up-to-date on all immunizations?*

YesNo
Attach immunization record and student school health forms, or waiver/ Email to Camp/ or Bring in person

Cancelof
Does your child have any food, medication, or environmental allergies?*

YesNo
Please list and explain any allergies*

*If your child’s allergy/allergies require camp staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child, parents must submit physician authorized medical plan0/200
Does your child have a special health or medical condition?*

YesNo
Please explain*

*If special health or medical condition require camp staff to perform a procedure, or perform child specific care such as: to monitor your child for symptoms or administer medication during camp hours, parents must submit a physician authorized medical plan0/200
Is your child currently using any medication, food supplement or medical food (such as electrolyte solution)?*

YesNo
Please explain*

*If medication, food supplement, or medical food needs to be administered at camp, parents must submit a physician authorized medical plan0/400
Does your child have any dietary restrictions, including those for medical, religious or cultural reasons?*

YesNo
Please explain*

*If child's dietary restriction require a modified diet that eliminates all types of fluid milk or an entire food group, parent's must submit in writing to Camp Director, and provide a physician authorized medical plan if applicable.0/400
List any history of hospitalization, outpatient surgery, or previous health concerns that would be needed to assist the staff or medical personnel in an emergency situation.*

0/400
List any additional information about your child that would be useful for staff to know, such as fears, eating or sleeping habits, or special routines. This information should not be medical or health related, as that information should be included in the previous questions.*

0/400
My Architecture Workshops Inc. and NOMAct has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*
Type first and last name above to consent
Sign Document*
Date Signed*

MonthDayYear

My Products*

Project Pipeline Registration Fee

Please note that the registration fee is non-refundable

$25.00

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

Parents' Information

Emergency Contacts/Authorized Pickup

Medical / Health Information

Payment Methods