Northwest Science Fair Extravaganza Online Registration

Registration and Release Form Please complete this form and return it to NSIS before the science fair.

Student Name: *

School: *

Grade: *

What science fair will you be attending?: *

Prince Rupert

Terrace

Kitimat

Registration Category: *

Individual

Group (max. 2)

Name of Partner (if in a group):

Parent Name: *

Phone Number: *

Email Address: *

Project Title: *

Brief Description of Project: *

Parent or Guardian Release and Consent

By entering in the parent name and child name below states that you agree and consent to the following. I, hereby grant Northwest Science & Innovation Society the right to take and use photographs for promotional purposes of my child at the Northwest Science Fair Extravaganza 2011.

Parent Name: photo release: *

Child Name: photo release: *

Parent Signature: *

I Agree and give my consent.

Selecting this check box represents your signature and authorization.

Date: *

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