IBM CyberDay4Girls REGISTRATION

In conjunction with the Community College Cyber Summit (3CS), Bossier Parish Community College is hosting two add-on activities for girls:

On July 29, 8:30 am - 3:00 pm, IBM's "CyberDay4Girls" for seventh and eighth grade girls, and
On July 30, 8:30 am - 4:00 pm, the Girl Scouts of America's Cybersecurity Badge.

A student may participate in either or both of these events. Use this form to sign up for IBM's CyberDay4Girls event. Please follow the link to the Girl Scouts Badge on the 3CS registration page to sign up for the Girl Scouts Cybersecurity Badge event.

Girl's Name

First NameLast Name

As of September 2019, what grade will the registrant be in?

Parent Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Area CodePhone Number

To register for IBM's CyberDay4Girls on July 29, check this box and sign IBM's Release Statement below:

CyberDay4Girls

RELEASE FORM for

#IBMCyberDay4Girls
Location: Bossier City, LA Date: July 29, 2019

I hereby irrevocably give my consent to International Business Machines Corporation (IBM), its affiliates, licensees, agents, successors and assigns, and to such other persons as they designate, to use my child's name, voice, verbal statements and portrait or picture (motion or still) for purposes of trade or for any lawful purpose whatever, in any media now known or hereafter developed.

I hereby agree and acknowledge that, to the extent permitted by law, IBM, its subsidiaries and affiliates and their servants and agents, shall not be liable for any claims for injury, loss or damage suffered in connection with my child’s participation in the event day activities and I release IBM, its subsidiaries and affiliates and their servants and agents, from any liability.

E-Signature: I agree that my typed name in the following online textbox has the same effect as my signature on a paper form.
________________________________

Signature of Parent or Legal Guardian

First NameLast Name