Explorathon 2018: A STEM Event Expanding Horizons for Girls in Science, Technology, Engineering, and Mathematics A joint project of the American Association of University Women Birmingham Branch, Ford Motor Company Fund, Cranbrook Institute of Science, and Cranbrook Schools. Purpose To provide students with interactive and hands-on workshop sessions featuring dynamic women scientists, engineers, mathematicians, and health care specialists; and to showcase opportunities for women in STEM (science, technology, engineering, and mathematics) careers. Date: Wednesday, March 21, 2018 Time: 7:45 a.m. 1:00 p.m. Location: Cranbrook Kingswood Middle School for Girls 39221 Woodward Avenue, Bloomfield Hills, Michigan 48303 (between Quarton/Big Beaver Rd. and W. Long Lake Rd) 248-770-8476 Please complete 1. Registration form 2. Parent Permission form and return to the Spirit Shop as soon as possible with $20 fee. The first 25 students will be accepted and a waiting list will be kept in case of cancellations.
Explorathon 2018 Registration Form (Please print legibly) Student Registration - Explorathon - Wednesday, March 21, 2018 Last name First name Address City State Zip Phone ( ) School: _Regina High School Grade Do you wish a vegetarian lunch? Yes No [NOTE: Must be pre-ordered.] Have you attended Explorathon before? Yes No Students: List below your workshop selections by letter and number in order of preference. (You will be assigned to three workshop sessions. If sessions are full, it may be necessary for us to make some substitutions.) Please select from at least two areas. 1. # 4. # 2. # 5. # 3. # 6. # Optional: I hereby consent and authorize Explorathon permission to photograph my child for media sources including newspaper, television, and brochures in connection with the activities in Explorathon. Parent/Guardian signature
PARENT PERMISSION FORM FOR ACTIVITY PARTICIPATION Dear Parent or Legal Guardian: Your daughter is eligible to participate in a school-sponsored activity requiring transportation to a location away from school premises. This activity will take place under the guidance and supervision of employees and/or parents from Regina High School. A brief description of the activity follows: Name of Event: Explorathon Destination: Designated Supervisor of Activity: Cranbrook Kingswood Middle School Mrs. Dulgerian Date and Departure/ Return Time: Wednesday March 21, 2018 Method of Transportation: Student Cost: Bus $20 payable to Regina High School includes lunch If you would like your daughter to participate in this event, please complete, sign, and return the following statement of consent and release of liability. As a parent or legal guardian, you ultimately remain fully responsible for the actions and conduct of your daughter. STATEMENT OF CONSENT I hereby consent to participation by my daughter,, in the event described above. I understand that this event will take place away from the school grounds and that my daughter will be under the supervision of the designated school employee. I further consent to the conditions stated above for my daughter s participation in this event, including the method of transportation. In consideration of my daughter being allowed to participate in this event, I hereby agree on behalf of myself and my daughter to release Regina High School, The Roman Catholic Archdiocese of Detroit, and any and all affiliated organizations, their employees, agents and representatives, including volunteer drivers (collectively Releases), from any and all claims, including negligence, which may be asserted by me or my child, or on behalf of my daughter, arising from or relating to my daughter s participation in the field trip. In the event this release on behalf of myself and/or my daughter is held to be invalid or unenforceable, I hereby agree to indemnify and hold harmless Releases from any and all claims, including negligence, which may be asserted by me or my child, or on behalf of my daughter, arising from or relating to my child s participation in the field trip. This release of indemnification does not apply to claims for intentional misconduct or gross negligence; nor does this release or indemnification apply to the extent of commercial insurance coverage for any claim, but this Release or Indemnification shall apply to the extent of any self-insurance or deductible applicable to any claim. I authorize Regina High School to obtain necessary medical treatment for my daughter in case of illness, injury or accident. My daughter has the following medical conditions or allergies about which a health care provider should be told: HEALTH INSURANCE DATA Company: Group: Policy: Contract: On the date(s) of this event, I can be reached at ( ) Parent s Name (Print) Parent s Signature Date (Rev. 10/09)