First Light Saturday Science School --- SPRING 2012 Registration is NOW OPEN! Register by April 6, 2012

Session Commences April 14, 2012

Who is eligible: DC residents in Grades 6, 7, and 8. Preference is given to student attending DCPS and Public Charter Schools. Acceptance is on a first-come basis.

When: Sessions run for 6 Saturdays 1-4PM (First day at 12:30PM)

Where: Carnegie Institution for Science 1530 P St. NW Washington, DC 20005

Important: Please print out and complete the Authorization Form and bring on the first day. All communications are via email so please provide addresses that you check often.

Applicant Information

First Name: *

Last Name: *

Address: *

Apt. #:

City: *

State: *

Zip Code: *

Primary Contact Phone Number: *

Primary Contact E-mail Address: *

Current Science Teacher:

Current School: *

Current Grade: *

Gender: *

Female

Male

Date of Birth (M/D/YR): *

Parent/Guardian Information

Mother (Female Householder)

First Name:

Last Name:

Home Address:

Home Phone:

Cell Phone:

Office Phone:

e-mail Address:

Father (Male Householder)

First Name:

Last Name:

Home Address:

Home Phone:

Cell Phone:

Office Phone:

e-mail Address:

Emergency Contact Information

Name:

e-mail:

Home Phone:

Office Phone:

Cell Phone:

Relationship:

Medical Contact

Physician/Health Service Name:

Physician/Health Service Phone No.:

Allergies or special medical condition:

Food restrictions:

CAPTCHA

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Math question: * 1 + 0 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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FirstLight-AUTHORIZATIONS-2011.doc	210.5 KB