Summer 2023 Rocketry Program

Thank you for your interest in the Science Club for Girls Summer 2023 Rocketry Program!

Science Club for Girls Summer 2023 Rocketry Program is open to all girls and gender expansive youth, who are rising 6th-8th graders.

If the number of applicants exceeds the number of spaces available, priority placement will be given to students who are underrepresented in STEM (students of color, students demonstrating economic need, and/or students who are first generation college bound), as per the mission of Science Club for Girls.

Submission of this application DOES NOT guarantee admission.

Priority will be given to students who have not previously participated in our summer rocketry program.

There is NO COST to attend this program

Select ONE Session:

· SESSION 1: July 10 – 21, Monday - Friday, 9:00am - 12:00pm

(This session will be in-person at Graham & Parks School in Cambridge)

· SESSION 2: July 31 – August 11, Monday - Friday, 9:00am - 12:00pm

(This session will be in-person at Graham & Parks School in Cambridge)

Return completed application by June 1, 2023

Thank you for your interest in the Science Club for Girls Summer 2023 Rocketry Program!

Science Club for Girls Summer 2023 Rocketry Program is open to all girls and gender expansive youth who are rising 6th-8th graders.

There is NO COST to attend this program!

Return completed application by June 1, 2023

Child's Information

Child's First Name

Child's Last Name

Optional Child's Preferred Name

Child's Date of Birth (MM/DD/YYYY)

T-Shirt Size

Child Address

Child Address 1

Child Address 2

Child City

Child State

Child Zip

2023-2024 Academic Year Information

Child's Grade (in fall 2023)

If child attends home school, please indicate "Home School" below.

School - Complete Name

School City

School State

Medical History: Please indicate any medical issues or conditions, such as allergies, that we should know about. For example, foods, latex, medicines, bee stings, asthma, etc. If no allergies or medical issues, please enter None. (255 characters maximum)

Accessibility: Science Club for Girls has made efforts to ensure our programs are inclusive to individuals with disabilities. If you find that our programs are not accessible to your child, please contact us at scfgprograms@scienceclubforgirls.org to discuss accommodations. Is there any important information we should know that will aid us in working with your child to ensure their success in Science Club for Girls? If there is no important information, please enter None. (255 characters maximum)

Science Club Selection

How did you hear about us?

Other Hear About Us

Family Considerations

Does your child have a sibling also applying for or currently participating in a Science Club for Girls program?

Sibling Name(s)

Are there any additional family circumstances that we should consider if the number of applicants exceeds the number of spaces available?

Session Selection

Please select the session you would like your child to participate in (NOTE: Sessions run from 9:00AM- 12:00PM on Monday- Friday)

Demographic Information

To keep Science Club for Girls' programs free, we get funding from many sources. Most ask for information about the background of our participants. Please help us keep Science Club for Girls FREE by filling out this information. This also helps make sure we reach a diverse group of participants.

All information is confidential. We will never share details about your specific child(ren). We share this information for all participants as a whole. For example: 40% of participants are Latina; 50% are from low income families.

Child's Racial/Ethnic Background

Other Racial/Ethnic Background

Is your child eligible for a Free/Reduced Lunch program?

What is the total income for the household at which your child resides?

How many people reside in your household?

What is the primary language spoken in your child's home?

Other Language

Please list any additional language spoken in your child's home:

Parent/Guardian 1 Highest Education Level

Parent/Guardian 2 Highest Education Level

Parent/Guardian Information

Any Parent/Guardian listed will have permission to pick up your child from Science Club.

Parent/Guardian 1 Information

The parent/guardian listed here will be the primary recipient of Science Club for Girls emails, including club enrollment, updates, and special events.

Parent/Guardian 1 Relationship to Child

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

Does Parent/Guardian 1 have the same address as your child?

Parent/Guardian 1 Address

Parent/Guardian 1 Address 1

Parent/Guardian 1 Address 2

Parent/Guardian 1 City

Parent/Guardian 1 State

Parent/Guardian 1 Zip

Parent/Guardian 1 Preferred Contact during Science Club hours:

Parent/Guardian 1 Mobile Phone

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Work Phone

Parent/Guardian 1 Email

Parent/Guardian 2 Information

If no Parent/Guardian 2, then leave blank.

Parent/Guardian 2 Relationship to Child

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Does Parent/Guardian 2 have the same address as your child?

Parent/Guardian 2 Address

Parent/Guardian 2 Address 1

Parent/Guardian 2 Address 2

Parent/Guardian 2 City

Parent/Guardian 2 State

Parent/Guardian 2 Zip

Parent/Guardian 2 Preferred Contact during Science Club hours:

Parent/Guardian 2 Mobile Phone

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Work Phone

Parent/Guardian 2 Email

Emergency Contact

In case of an emergency and a parent/guardian cannot be reached, please indicate an Emergency Contact that we may reach during Science Club hours:

Emergency Contact Name

Emergency Contact Phone Number

Relationship to Emergency Contact

Additional Permissions

Please indicate any additional adults, other than those already listed, who have your permission to pick up your child from Science Club.

For your child's safety, we will only allow this people listed on this form to pick up your child. They will need to show a photo ID and sign her out each time.

Pick Up 1 Name

Pick Up 1 Phone Number

Pick Up 2 Name

Pick Up 2 Phone Number

Granting Permissions

Child's Full Name

Parent or Guardian's Name

Today's Date

Permission to Participate

Your child is welcome to participate, free of charge, in Science Club for Girls. Participants are expected to behave in a safe and respectful manner. SCFG has the discretion to dismiss any child whose actions are disruptive to the learning environment.

I give permission for my child to participate in Science Club for Girls (SCFG) during the Summer 2023 semester. I understand that my child will be under the supervision of the SCFG staff and/or volunteer mentors who are trained, supervised and CORI background checked by SCFG. In consideration of my child being allowed to participate in these programs at no financial cost, I hereby agree on behalf of myself and my child, to release the SCFG, its employees, agents and volunteers from any and all claims including negligence, which may be asserted by me or my child, or on behalf of my child, arising from or relating to my child’s participation in any program offered by the SCFG.

I understand that regular attendance and good behavior are essential to the educational experience of participating in Science Club for Girls programming, and I have reminded (and will continue to remind) my daughter of the importance of both. I also understand that SCFG programs are continually evaluated for quality and effectiveness, and that my child will be part of these activities, but that data gathered will be shared only in aggregate with no individual identifying information.

I understand that submission of this application does not guarantee acceptance into a Science Club for Girls program.

Please note participants will be need to fill out a separate permission slip for the rocket launch field trips. These will be issued during the rocketry program. Participants will need to arrange for drop off and pick up.

Permission to participate - please select:

Permission to Participate

If you choose "No" to the preceding question, your child's application will be discarded and she will not be placed in a Science Club for Girls program. If you wish to proceed with this application, please select "Yes" above.

Please note participants will need to fill out a separate permission slip for the rocket launch field trips. These will be issued during the rocketry program.

(SCFG) Image Release

On behalf of my minor child, I hereby acknowledge and voluntarily consent to the use of my child’s photograph, video footage or other likeness and description of her/him (collectively, the “Likeness”) by Science Club for Girls, Inc. (including its successors and assignees, “SCFG”) and by any organization that sponsors or partners with SCFG in the Summer Rocketry Program or other SCFG Programming (collectively, the "Sponsors") in any of SCFG’s or Sponsors' website, video projects, organizational communications, promotional materials, including but limited to social and other media, as SCFG/ Sponsors see fit from time to time, in edited or unedited state, whether individually or collectively, for any and all purposes consistent with SCFG’s mission and as a 501(c)(3) tax exempt organization and for Sponsor’s related non-commercial purposes. I understand that my child’s first name may be disclosed but that SCFG and Sponsors will not, without my prior written consent, disclose my child’s full name.

I release SCFG (including but not limited to its current and former employees, officers, directors and agents) and Sponsors from any liability for any and all claims of any kind on account of, arising out of or relating to the use, publication, duplication, dissemination, public display or other use or disclosure of the Likeness permitted by this Image Release.

I understand and agree that neither I or my child will receive any compensation for the use, publication, duplication, dissemination, public display or other use or disclosure of the Likeness, and that neither of us have a right to inspect or approve any finished product or program incorporating the Likeness. I further understand and agree that SCFG is the sole owner of any and all Likenesses and has the authority to grant Sponsors permission to use Likenesses in accordance with this Image Release.

Permission for Image Release - please select:

By clicking “Submit” below,

I certify that I have read, fully understand and accept all terms of the foregoing statement

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