Build Smart Challenge Registration

Please complete the below registration form in its entirety to register for the STEMz Project Build Smart Challenge.

This competition is limited to 20 students, and students must be in grades 7-12. Once your registration has been submitted, it will be reviewed by STEMz Project admins. You will receive a notification email upon registration approval.

Student Information

Student Name*

Student Gender*

Student Date of Birth*

Student Grade (2021-22 School Year)*

Name of School Student Attends*

Student Email Address

Student Phone Number

Student Standard Shirt Size*

Please indicate any allergies or medical/behavioral conditions program staff should be aware of.

Please share any special accommodations needed in order for the student to participate in the program.

Primary Parent/Guardian Information

Primary Parent/Guardian Name*

Primary Parent/Guardian Email Address*

Primary Parent/Guardian Phone Number*

Primary Parent/Guardian Home Address*

Would You Like to Add an Additional Parent/Guardian's Information?*

Yes

Secondary Parent/Guardian Information

Secondary Parent/Guardian Name*

Secondary Parent/Guardian Email Address*

Secondary Parent/Guardian Phone Number*

Secondary Parent/Guardian Home Address*

Transportation Information

Will the student be driving themselves to/from this program?*

Yes

Not Sure

Please list the authorized individual(s) with permission to pick up the student from each session.

Individual's Full Name

Relationship to Student

Phone Number

In the case of an emergency, please contact the below person(s).*

Individual's Full Name

Relationship to Student

Phone Number

By checking the box below, I confirm the student has reliable transportation to and from the program.*

I confirm

By checking the box below, I confirm the student can attend all session dates in the Build Smart Challenge.*

I confirm

Carefully Review our Terms and Conditions and Media Release

By checking the box below, I accept all the terms and conditions for the Build Smart Challenge.*

I agree to the Terms & Conditions

By checking the box below, I agree to the media release for the Build Smart Challenge.*

I agree to the Media Release

How Did You Hear About the Build Smart Challenge?