Adventure In High Tech Student Registration

Adventure in High Tech 2023

Note to Sponsoring Rotary Club: Send this link to each of your students and ask them to complete this form online and then click on Submit to return it to us by the October 8, 2023 deadline.

Sponsoring Rotary Club Name *

First Name *

Last Name *

Address (Unit or Apartment Number, if applicable)

Address (Street Number and Name) *

Address (CityTown) *

Address (Province) *

Address (Postal Code) *

Cellular Number *

Email *

Age *

Sex *

Grade *

Does the student require any special accommodation? *

If Yes, please specify what special accommodation is required:

I agree to the following Photo/Image Release and Waiver *

By participating in the Adventure in High Technology Program, the student gives The Rotary Club of Nepean-Kanata the irrevocable right to use their name/photograph/image/audio recording/video recording/ and likeness in all forms and manner including but not limited to publication on Internet Web Sites, broadcasts and any other publications as released to or by The Rotary Club of Nepean-Kanata. The student understands that Rotary Club of Nepean-Kanata cannot control unauthorized use of this information by persons not associated with The Rotary Club of Nepean-Kanata once it has been published.