Registration for STEM4US! Hackathon 2025 Parent/Guardian Name * First Name Last Name Parent/Guardian Phone * (###) ### #### Parent/Guardian Email * Address * Where can we mail your student's on-boarding package and prizes Parent's Social Media How can we reach you on social media Parent School/Organization * At what school, business, organization do you attend or work? If none, indicate that. Student Name * First Name Last Name Student Email * Student Age * Student Grade * School * At what school does your student attend? 💻 Program Access Device Access * Does your child have access to a device suitable for Zoom and virtual coding sessions? Yes No 💻 Internet Access * Is your child’s internet connection stable enough to participate in Zoom and coding activities? Yes No ⚖️ Waiver of Liability and Media Release (Remote-Only Participation) * By submitting this form, I acknowledge and agree to the following on behalf of myself and my child: Voluntary Participation: My child and I are voluntarily participating in the STEM4US! 2025 Virtual Ag-Tech Hackathon organized by STEM4US! and its partners, and we understand this event will be conducted entirely online. Assumption of Risk: We understand that participation may involve the use of online platforms (e.g., Zoom, Hopin, Google Classroom) and that STEM4US! is not responsible for any issues arising from internet connectivity, device malfunction, or interruptions beyond its control. Supervision and Conduct: I accept full responsibility for supervising my child during all virtual activities and ensuring appropriate behavior and engagement. Liability Release: I release and hold harmless STEM4US!, Virginia State University, event sponsors, staff, mentors, volunteers, and affiliates from any and all liability related to personal injury, data breach, or technology-related issues resulting from our participation in this virtual program. Media Consent: I grant permission for photographs, video recordings, or screenshots that include me or my child to be used by STEM4US! and its partners solely for educational or promotional purposes. Code of Conduct: We agree to follow the program’s code of conduct and respect all participants, staff, and volunteers during the event. Yes Student’s Current Level of STEM Training Beginner – New to tech Intermediate – Some school-based exposure Advanced – Participated in previous STEM/tech programs 📊 Participant Profile (for impact reporting only) * All data is confidential and will be used only in our final impact report and to improve programming. Student Interests (Check all that apply) Coding Strongly Disagree Disagree Neutral Agree Strongly Agree Drone Technology Strongly Disagree Disagree Neutral Agree Strongly Agree Gaming Strongly Disagree Disagree Neutral Agree Strongly Agree AI Strongly Disagree Disagree Neutral Agree Strongly Agree Agriculture/Farming Strongly Disagree Disagree Neutral Agree Strongly Agree Working at a Grocery/Restaurant Strongly Disagree Disagree Neutral Agree Strongly Agree Business/Entrepreneurship Strongly Disagree Disagree Neutral Agree Strongly Agree Religion/Faith Strongly Disagree Disagree Neutral Agree Strongly Agree Other Strongly Disagree Disagree Neutral Agree Strongly Agree 📊 Participant Profile (for impact reporting only) * All data is confidential and will be used only in our final impact report and to improve programming. Student Interests (Check all that apply) Coding Strongly Disagree Disagree Neutral Agree Strongly Agree Drone Technology Strongly Disagree Disagree Neutral Agree Strongly Agree Gaming Strongly Disagree Disagree Neutral Agree Strongly Agree AI Strongly Disagree Disagree Neutral Agree Strongly Agree Agriculture/Farming Strongly Disagree Disagree Neutral Agree Strongly Agree Working at a Grocery/Restaurant Strongly Disagree Disagree Neutral Agree Strongly Agree Business/Entrepreneurship Strongly Disagree Disagree Neutral Agree Strongly Agree Religion/Faith Strongly Disagree Disagree Neutral Agree Strongly Agree Other Strongly Disagree Disagree Neutral Agree Strongly Agree Thank you!
