Student Registration

Student Last Name *

Student First Name *

Name on Certificate (Optional)

Student Contact Email Address *

Mother's Email Address

Mother's First Name

Mother's Last Name (if different from student's)

Father's Email Address

Father's First Name

Father's Last Name (if different from student's)

Home Phone

Mother's Mobile

Father's Mobile

Address

City

State/Province

ZIP/Postal Code

T-Shirt (Adult Size) *	Small Med Large X-Large XX-Large

Grade *

Basic Education Teacher *

Build Event

Academic Event 1 *

Academic Event 2

Academic Event 3

Academic Event 4

Parent Volunteer Signup *