Young Women Empowered · Y-WE STEM Exploration Day 2018

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Y-WE STEM Exploration Day 2018

Saturday, January 26th

11am-4pm

Microsoft, Redmond Campus

Women, girls, and female-identified youth welcome

Contact programs@y-we.org with questions

Participant Information

Y-WE STEM Exploration Day is an event primarily for women, girls and female-identified youth ages 13-18. Y-WE STEM Exploration Day takes place Saturday, January 26, 2019 at Microsoft, Redmond Campus from 11am-5pm. Please complete and submit this registration in ONE session. You WILL NOT be able to save the online form mid-way through.

Contact Information

Name

First Name

Last Name

I am a:

Youth (under 18)

Adult Ally (ages 18+)

Ambassador (adult bringing a group)

Age

What is the name of your school or place of work?

Do you identify as a person of color? (optional)

Yes

Ethnicity/Culture/Race (Optional)

If you are an ambassador bringing a group, what is the name of the organization or school that your participants are from (if any)?

If you are an ambassador bringing a group, how many youth are in your group?

If you are an ambassador registering a group, please list their names here:

Best Contact Email

Best contact phone number for you

Best address to mail you info about Y-WE STEM Exploration Day

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Parent/Guardian Name (if under 18)

First Name

Last Name

Parent/Guardian E-mail Address (if under 18)

Parent/Guardian Phone Number (if under 18)

Dietary Preference (check all that apply)

I eat everything!

Vegetarian

Vegan

No Pork

Gluten Free

No Dairy

Nut Allergy

Other

If you selected "other" or you are an ambassador registering a group, please explain your dietary needs:

How will you get to our program?

Drive myself or my group

Parent/Guardian will drive me

Public Transport

I need Y-WE to arrange a ride

If you need Y-WE to arrange a ride, please select a pick-up point that you could get yourself to in order to catch a Y-WE shuttle:

Neighborhood House, West Seattle

Denny Middle School, West Seattle

Garfield Community Center, Central District

El Centro De La Raza, Beacon Hill

Foster Library, Tukwila

Decatur High School, Federal Way

Shoreline Public Library

Kirkland Public Library

Redmond Public Library

If none of the pick-up points above will work for you, please list 2-3 possible alternative pick-up points in your area:

If a parent/guardian is driving you, are they able to pick other youth up who need transport?

Yes

Number of seats available in your vehicle:

How did you learn about Y-WE STEM Exploration Day?

What do you hope to gain from participating in Y-WE STEM Exploration Day?

Do you need any special accommodations?

Y-WE is dedicated to creating inclusive spaces and programs for all, including people with disabilities and specific accommodation needs

Y-WE Photo Waiver

At Y-WE STEM Exploration Day we will be taking photos and videos to be used in future Y-WE materials and publications. Are you ok with having your photo taken by Y-WE?

Yes

If you are under 18 years old, please write the name of your parent/guardian who is giving permission:

Emergency Contact Information

Please fill this section out carefully and provide info for TWO emergency contacts.

#1 Name of Emergency Contact

First Name

Last Name

#1 Emergency Contact Phone

#1 Relationship to you or your group

#2 Name of Emergency Contact

First Name

Last Name

#2 Emergency Contact Phone

#2 Relationship to you or your group

By registering, I understand that I am committing to attend Y-WE STEM Exploration Day.