BioSpark Middle School - Workshop Registration Form

Student Name

First NameLast Name

Student Email

example@example.com

Student Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Birth Date

MonthDayYear

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address (if different from Attendee)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current School Attending

School District

Grade Level

Biology Teacher's Name

First NameLast Name

Biology Teacher's Email

example@example.com

Have you participated in any of the following activities? (Check all that apply)

School and Community Activities/Leadership Positions

List any science-related awards, certifications, or achievements

How did You learn about Workshop?

Other

Middle School Weekend Workshop

Pay Full Fee Now - $199

Via Credit Card

$199.00 Quantity

Pay through Zelle - $199

Use: Info@AlamoBioCenter.com

Free Quantity

Opt Payment Plan - $250

Non-refundable $50 is due now to reserve your spot.

Total fee for the program due before the day of the workshop.

$50.00 Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, the undersigned participant (or parent/legal guardian of the participant if under 18), acknowledge that participation in the BioSpark Biotech Bootcamp at Alamo BioCenter involves hands-on laboratory activities, including but not limited to working with biological materials, laboratory equipment, and chemicals. I understand that participation in these activities carries inherent risks, including but not limited to exposure to laboratory reagents, accidental injury, or unforeseen hazards associated with a working lab environment.

ASSUMPTION OF RISK I voluntarily assume full responsibility for any risks of injury, illness, damage, or loss that may result from participation in this program. I acknowledge that Alamo BioCenter follows safety guidelines and protocols to minimize risks, but I accept that complete elimination of risks is not possible.

WAIVER AND RELEASE OF LIABILITY I hereby release, waive, discharge, and hold harmless Alamo BioCenter, its directors, employees, mentors, instructors, and affiliates from any and all liability, claims, demands, or causes of action arising out of or related to any loss, injury, illness, or damage that may occur during or as a result of my/my child’s participation in the BioSpark Biotech Bootcamp, whether caused by negligence or otherwise.

MEDICAL AUTHORIZATION In the event of an emergency, I authorize Alamo BioCenter staff to seek medical treatment for me/my child, including transportation to a medical facility if deemed necessary. I understand that I am responsible for any medical expenses incurred.

CODE OF CONDUCT I acknowledge that all participants are expected to adhere to the program’s safety protocols and behavioral guidelines. Any participant who fails to follow instructions or engages in unsafe or disruptive behavior may be dismissed from the program without refund.

PHOTO/VIDEO RELEASE (Optional) I grant permission for Alamo BioCenter to use photographs and/or video recordings of me/my child taken during the program for promotional, educational, and informational purposes.

ACKNOWLEDGMENT AND e-SIGNATURE By signing below, I confirm that I have read and fully understand this liability waiver. I voluntarily agree to the terms outlined above by printing my name on this form below:

Parent/Guardian Signature (if under 18 else type NA):

Today's Date and Date of signing this Form:

Date

Middle School Workshop

Middle School Weekend Workshop

ALAMO BIOCENTER BIOTECH BOOTCAMP LIABILITY WAIVER

Middle School Workshop

Middle School Weekend Workshop*

ALAMO BIOCENTER BIOTECH BOOTCAMP LIABILITY WAIVER

Middle School Weekend Workshop