Biosphere 2 2014 Science Academy Registration Form

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* 1. Student Participant Information

Last Name:

First Name:

Age:

Date of Birth:

Gender:

Nickname (or what student prefers to be called):

SCHOOL NAME, City and State (Spring 2014):

SCHOOL NAME, City and State (Fall 2014):

Grade in Fall 2014:

Home Address:

City:

State:

Zipcode:

Email Address:

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* 2. DISABILITY / LIMITATION INFORMATION (Please advise of any disabilities/concerns that we should be aware of)

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* 3. PARENT / GUARDIAN INFORMATION

Parent/Guardian 1: Last Name

First Name:

Primary Phone Number:

Secondary Phone Number:

e-mail Address:

Parent/Guardian 2: Last Name

First Name:

Primary Phone Number:

Secondary Phone Number:

e-mail Address:

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* 4. BIOSPHERE 2 SCIENCE ACADEMY WEEK SELECTION (check one)

July 6-12, 2014 (for 6-9th grade students)

July 13-19, 2014 (for 9-12th grade students)

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* 5. DEPOSIT / PAYMENT INFORMATION

Credit Card: Contact Nancy Boklund at (520) 838-6192

Checks: payable to U of A, Biosphere 2 (please write student's name and "Science Academy" on memo line). Mail To: Biosphere 2 Science Academy, Attn: Nancy Boklund, P.O. Box 8746 Tucson, AZ 85738

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* 6. UPON ARRIVAL, STUDENTS WILL RECEIVE
a Biosphere 2 t-shirt, hat, water bottle, and notebook.
Please indicate the shirt size needed (in men's sizes).

Small

Medium

Large

X-Large

2X-Large

Other Size (please specify)

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* 7. DROP-OFF and PICK-UP AUTHORIZATION

Please only provide names of those, other than parents/guardians listed above, who are authorized to pick up your student. IDENTIFICATION WILL BE REQUIRED.

Authorized Person 1: (first and last name, phone number)

Authorized Person 2: (first and last name, phone number)

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* 8. CHECK-IN and CHECK-OUT:
Sunday Student Check-in: Noon - 3PM
Saturday Student Symposium: 10AM, FAMILIES ARE WELCOME!
Saturday Student Check-out: Noon - 2PM

Please indicate if you would like Biosphere 2 to provide student transportation TO and/or FROM the Tucson International Airport ($25 each way per student). We will follow up regarding details.

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* 9. EXPECTATIONS: Please describe briefly your expectations of the B2 Science Academy

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* 10. ADDITIONAL INFORMATION THAT YOU MAY WANT TO SHARE:

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* 11. How did you hear about the Biosphere 2 Science Academy?

Biosphere 2 Website

Social Media

School or Teacher

Biosphere 2 Visit

Print Media

Other (please specify)

Your voluntary, electronic submission of these forms serves as your signature in place of a traditionally signed paper form. By submitting payment and completing the forms online you are authorizing that the information provided is correct and that you are intending to register your student in the 2014 Biosphere 2 Science Academy.

Question Title

* 1. Student Participant Information

Question Title

* 2. DISABILITY / LIMITATION INFORMATION (Please advise of any disabilities/concerns that we should be aware of)

Question Title

* 3. PARENT / GUARDIAN INFORMATION

Question Title

* 4. BIOSPHERE 2 SCIENCE ACADEMY WEEK SELECTION (check one)

Question Title

* 5. DEPOSIT / PAYMENT INFORMATION

Question Title

* 6. UPON ARRIVAL, STUDENTS WILL RECEIVEa Biosphere 2 t-shirt, hat, water bottle, and notebook.Please indicate the shirt size needed (in men's sizes).

Question Title

* 7. DROP-OFF and PICK-UP AUTHORIZATIONPlease only provide names of those, other than parents/guardians listed above, who are authorized to pick up your student. IDENTIFICATION WILL BE REQUIRED.

Question Title

* 8. CHECK-IN and CHECK-OUT:Sunday Student Check-in: Noon - 3PMSaturday Student Symposium: 10AM, FAMILIES ARE WELCOME!Saturday Student Check-out: Noon - 2PM

Question Title

* 9. EXPECTATIONS: Please describe briefly your expectations of the B2 Science Academy

Question Title

* 10. ADDITIONAL INFORMATION THAT YOU MAY WANT TO SHARE:

Question Title

* 11. How did you hear about the Biosphere 2 Science Academy?

* 6. UPON ARRIVAL, STUDENTS WILL RECEIVE
a Biosphere 2 t-shirt, hat, water bottle, and notebook.
Please indicate the shirt size needed (in men's sizes).

* 7. DROP-OFF and PICK-UP AUTHORIZATION

Please only provide names of those, other than parents/guardians listed above, who are authorized to pick up your student. IDENTIFICATION WILL BE REQUIRED.

* 8. CHECK-IN and CHECK-OUT:
Sunday Student Check-in: Noon - 3PM
Saturday Student Symposium: 10AM, FAMILIES ARE WELCOME!
Saturday Student Check-out: Noon - 2PM