Behind the Screen: 3D Printing

Permission Slip
Name of Behind the Screen: 3D Printing Participant:
Birthday of Behind the Screen: 3D Printing Participant:
Grade of Behind the Screen: 3D Printing Participant:
Parent Name:
Parent Email:

Parent Phone:

Parent/Guardian 2:
Parent/Guardian 2 Email:

Parent/Guardian Phone:

Please Note:
The Chattanooga Library does not have or provide medical or accident insurance for persons involved in
Behind the Screen: 3D Printing
Permission to Participate:
By signing below, I,

___ as the legal guardian, give

(parent name)

_____________________________, permission to participate in Behind the Screen: 3D Printing.

(participant name)
Signature_______________________________________ Date______________________
Medical Release Permission
Participant Name

Date of Birth

I give permission for my daughter to participate in BEHIND THE SCREEN: 3D PRINTING activities. In
case of an emergency, I understand that BEHIND THE SCREEN: 3D PRINTING leaders will make every
effort to contact me. In the event that I cannot be reached, I hereby authorize BEHIND THE SCREEN: 3D
PRINTING to secure proper medical attention, including hospitalization, and ambulance transportation, if
needed. I understand that BEHIND THE SCREEN: 3D PRINTING is not liable for any medical expenses
that may be incurred, and that I am responsible for these costs in entirety.
I understand that BEHIND THE SCREEN: 3D PRINTING will not administer medication to my daughter. It
is my daughters responsibility to take medication that may be prescribed to her. I also understand and
will communicate to my daughter her responsibility to carry any medication on field trips or excursions.
Signature______________________________________Date___________________
(parent)

Participant Name and Parent Contact Information

Participant Name:
BEHIND THE SCREEN: 3D PRINTING is supported by NCWIT (National Center for Women and IT),
although it not officially a part of NCWIT and operates completely separately from the NCWIT
organization. NCWIT would like to track the middle school participants in the program in order to reach
out to them directly with college scholarship and high school award opportunities that are a part of
NCWITs programming and mission. The Program Leaders for BEHIND THE SCREEN: 3D PRINTING
are a part of this Award Program, called Aspirations in Computing. By signing below, I give my consent to
have contact information shared with NCWIT for this purpose.
Print:_______________________________________
Signature of Parent or guardian

Date

Internet Use Policy and Permission Form

Participants of BEHIND THE SCREEN: 3D PRINTING will utilize the internet as a tool for learning and
growth.
Emailing may be permitted at designated times and monitored closely by staff and volunteers as part of
programming.
BEHIND THE SCREEN: 3D PRINTING may block certain websites from girls use.
Girls are not permitted to visit websites or send electronic mail that contains ethnic slurs, racial epithets,
or anything that may be construed as harassment or belittling of others based on their sex, race, national
origin, age, disability, or religion.
BEHIND THE SCREEN: 3D PRINTING reserves the right to determine when a girl is sending excessive
or improper electronic mail. Transmission of any material in violation of any national or state regulation is
prohibited. This includes but is not limited to: copyrighted materials, threatening or obscene materials or
material protected by trade secret.
By signing below, I understand the internet policies listed above and agree to support my
daughter to abide by them at BEHIND THE SCREEN: 3D PRINTING.
Print Name:_________________________
Signature of Parent/Guardian

Date