TECHAPALOOZA APPLICATION

Student's Name:

Email:

Date of Birth:

Gender:

Home School District:

Grade Entering:

Parent/Guardian:

Address:

Home Phone:

Parent Work Phone:

Parent Cell Phone:

Emergency Contact Name 1:

Relationship to Student:

Emergency Phone:

Emergency Contact Name 2:

Emergency Phone 2:

Relationship to Student:

List emergency medical information (allergies, conditions, etc.):

I grant permission for my child to be photographed, recorded and/or interviewed for TST BOCES websites, social media sites and the media: YesNo

Please indicate your first, second and third choices by numbering them 1,2,3 and indicating the title of the offering (offerings listed above):

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