Let's Ride

Phone number
000-000-0000
Address
Child's Age
Gender
T-shirt size
Child: What grade and school are you entering in 2019-2020 school year?
Child: Have you participated in any Science, Technology , Engineering, Math or Business programs outside of school? If so, please list below.
Child: What would you benefit from participating in this program?
Child: How will you take what you've learned from this program to better your community?
Child: Why are you interested in this program?
Child: If you had the opportunity- what type of business would you start and why?
Child: What is one of your ultimate career goals?
List allergies and/ or special accommodations?
List Emergency Contact
Name, relationship, phone number
Parent/Child: Are you able to commit to the entire 7- week program
Only 2 excused absences are allowed.
Parent Signature , Type Full Name( First & Last) and Date
Sign, Print and Date
How did you hear about this program?
Facebook, Library, Friend etc.
I agree to pay the application Fee of $75 no later than 06/01/2019. I will contact Tech Needs Us, if I need an application fee waiver due to my family size/income.
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