SER Community Day Registration

Open to all school and individuals interested in attending.

School Information
School Name*
School Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
School Phone Number*
Principal's Name*
Prefix First Last
Principal's Email*
Chaperones
We ask that each attending school has one chaperone per every 10 students and/or meet their ISD requirements.
Chaperone Information*
Enter the required information for each of the chaperones here. Please add additional rows by clicking the + button to the right of each row.
Prefix First Name Last Name Email Phone Number
Students
Student Information*
Enter the required information for all attending students here. Please add additional rows by clicking the + button to the right of each row.
First Name Last Name Gender (M or F) Grade (9, 10, 11, or 12) Member of Robotics Team? (Yes or No)
How did you find out about the program?*
If "Other" please specify here:

School Information

First Name	Last Name	Gender (M or F)	Grade (9, 10, 11, or 12)	Member of Robotics Team? (Yes or No)

Prefix	First Name	Last Name	Email	Phone Number