Inside Out Club Business Designers 4 Good Workshop Registration

ENTREPRENEURSHIP – LEADERSHIP – SOCIAL RESPONSIBILITY – EMOTIONAL INTELLIGENCE

Register your student(s) for a Business Designers 4 Good Workshop

and empower them with the skills them need for a lifetime

Step 1 of 6

Summer Workshop Session Selection(Required)

Molex Headquarters - July 24-28th, 1pm-5pm (10 spots left)

How many students are you registering today?(Required)

Summer Workshop

Please enter a number from 1 to 3.

Adult Name(Required)

First Last

Relationship to Student(s)(Required)

Email(Required)

Phone(Required)

Phone Type(Required)

Text Message Reminders

We send out club meeting reminders and updates via text. If you would not like these text messages, please select the circle below.

Please don't text me

Address(Required)

Street Address Address Line 2 City State ZIP Code

Additional Adult(Required)

Would you like to add an additional adult to serve as an emergency contact in case you are unable to be reached? This adult may also pick up your student(s).

Yes

Additional Parent or Guardian

Adult Name(Required)

First Last

Relationship to Student(s)(Required)

Email(Required)

Phone(Required)

Phone Type(Required)

Text Message Reminders

We send out club meeting reminders and updates via text. If you would NOT like these text messages, please select the circle below.

Please don't text me

Address

If the second adult has a different address from the one already provided, enter it here.

Street Address Address Line 2 City State ZIP Code

Student(s) Information

I confirm that myself or the other adult entered above with pick up my student(s) promptly(Required)

Yes, confirmed

Please Note: If someone other than the adult(s) registered via this form today will be picking up your student from the workshop, please email their name and phone number to marion@insideoutclub.org.

Student #1's Name(Required)

First Last

Nickname

Gender(Required)

Race(Required)

Student's School Email(Required)

Participants will be using Chromebooks provided by Inside Out Club for the workshop. Use includes, but is not limited to, research on the internet, using Google products including Google sites, slides and surveys. In order to fully participate, we need the participant's school email that can access Google products. Chromebooks will be provided by IOC and will remain on site at the workshop location.

Cell Phone

If your student has a cell phone, please enter that number here. If not, please leave blank.

Text Messages

We send text reminders during the program and will send survey links periodically to measure long-term impact. If you are NOT ok with this, please click the circle below.

Please don't text my student

Grade(Required)

Enter students grade for the 2023-2024 school year. Student's must be entering 7th or 8th grade.

Child's High School Graduation Year(Required)

Example: 2029

Student's School(Required)

Please type the full school name of the middle school this student attends during the school year.

School District(Required)

Write the full name of the school district.

Medical Information

Please include medical or allergy information we need to be aware of.

Student #2 Information

Student's Name(Required)

First Last

Nickname

Gender(Required)

Race(Required)

Student's School Email(Required)

Cell Phone

If your student has a cell phone, please enter that number here. If not, please leave blank.

Text Messages

We send text reminders during the program and will send survey links periodically to measure long-term impact. If you are NOT ok with this, please click the circle below.

Please don't text my student

Grade(Required)

Grade entering for the 2023-2024 school year. Participants must be entering 7th or 8th grades.

Child's High School Graduation Year(Required)

Example: 2029

Student's School(Required)

Please type the full school name of the middle school this student attends during the school year.

School District(Required)

Write the full name of the school district.

Medical Information

Please include medical or allergy information we need to be aware of.

Student #3 Information

Child's Name(Required)

First Last

Nickname

Gender(Required)

Race(Required)

Student's School Email(Required)

Cell Phone

If your student has a cell phone, please enter that number here. If not, please leave blank.

Text Messages

We send text reminders during the program and will send survey links periodically to measure long-term impact. If you are NOT ok with this, please click the circle below.

Please don't text my student

Grade(Required)

Enter the grade your student will be in for the 2023-2024 school year. Participants must be entering 7th or 8th grades.

Child's High School Graduation Year(Required)

Example: 2029

Student's School(Required)

Please type the full school name of the middle school this student attends during the school year.

Student's School District(Required)

Enter the full name of the school district.

Medical Information

Please include medical or allergy information we need to be aware of.

Inside Out Club Business Designers 4 Good Workshop Registration

Register your student(s) for a Business Designers 4 Good Workshop

and empower them with the skills them need for a lifetime

Additional Parent or Guardian

Student(s) Information

Student #2 Information

Student #3 Information

Terms of Participation & Release of Liability

Video & Photo Release

COVID-19 Guidelines