Please fill out the following information for any child(ren) you have participating in a Techbridge Girls program.

The information you provide helps us keep in touch with you and let you know about important events. The demographic information in this form is only used anonymously.

We collect it to show funders the populations of students our programs serve.
Questions with a * are required
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What is your child's first name? *

 
What is your child's last name? *

 
What is your child's phone number?

You can leave this blank if your child doesn’t have her own phone number.
 
What city is your address in? *

 
What state is your address in? *


 
What is your street address? *

 
What is your zip code? *

 
When is your child's birthday? *

 
Does your child have any food restrictions or food allergies (vegetarian, vegan, dairy, gluten, nuts, etc)? *

     
 
If yes, please explain: *

 
Does your child have any other allergies? *

     
 
Can you provide more details on the allergy? *

 
Does your child or her school carry any important medication that Techbridge Girls should be aware of (inhaler, EPI pen, etc.)? *

     
 
Please explain: *

 
What ethnicity best describes your child? (Please choose all that apply)


 
Please describe their ethnicity:

 
Does your child have any special needs that Techbridge Girls needs to be aware of? *

     
 
Please share anything you would like us to know about your child's special needs: *

 
Does your child qualify for free/reduced lunch? *


 
In the case we are able to offer a T-shirt, what size is your child? *


 
Will you have more than one child in the program? *

     
 
What is your second child's first name? *

 
What is {{answer_59891725}}'s last name? *

 
What is {{answer_59891725}}'s phone number?

You can leave this blank if your child doesn’t have her own phone number.
 
When is {{answer_59891725}}'s birthday? *

 
Does {{answer_59891725}} have any food restrictions or food allergies (vegetarian, vegan, dairy, gluten, nuts, etc)? *

     
 
If you you answered yes, please explain: *

 
Does {{answer_59891725}} have any other allergies? *

     
 
Can you provide more details on {{answer_59891725}}'s allergy? *

 
Does {{answer_59891725}} or her school carry any important medication that Techbridge Girls should be aware of (inhaler, EPI pen, etc.)? *

     
 
Please elaborate: *

 
What ethnicity best describes {{answer_59891725}}? (Please choose all that apply)


 
Please describe {{answer_59891725}}'s ethnicity:

 
Does {{answer_59891725}} have any special needs that Techbridge Girls needs to be aware of? *

     
 
Please explain ({{answer_59891725}}): *

 
Does {{answer_59891725}} qualify for free/reduced lunch? *


 
In the case we are able to offer a T-shirt, what size is {{answer_59891725}}? *


 
Your turn! What is your first name? *

 
And your last name? *

 
Do you have an email address? *

     
 
What do you do for work? (electrician, bus driver, teacher, scientist, nurse, etc.)

If Applicable...
 
What is your home phone number?

Leave blank if you don’t have a work/home/cell phone
 
What is your cell phone number?

Leave blank if you don’t have a work/home/cell phone
 
Lastly, what is your work phone number?

Leave blank if you don’t have a work/home/cell phone
 
What's the best way to contact you? *


 
If you would like materials translated, please indicate the language:

*Based upon demand, we cannot guarantee all Techbridge Girls documents will be translated into your preferred language. 

 
If we could translate materials for you, what language do you prefer?

 
Please choose one option regarding your child’s transportation home: *


 
Please check any terms that apply to your family: *


 
Please choose your annual household income range: *


 
Techbridge also relies on volunteer support to keep our program accessible. Are you able to volunteer this year? *

     
 
How can you help?


 
What languages could you use in making phone calls to other parents?


 
In case the parent/guardian cannot be reached, please provide an emergency contact. What is the full name of your emergency contact? *

 
If we cannot reach you, what's the best number for your emergency contact? *

 
What is the relationship of your emergency contact to your child? *

Thank you for registering your child(ren) for Techbridge Girls!
Our team will be in touch with the next steps. 
Follow us on social media for updates on the program!
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Unfortunately Techbridge Girls isn't available at your school right now.
Stay in touch through our social media for updates on when Techbridge Girls will start at your school.
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