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Bring Your Child to Work Day 2024
Registration Form
REMINDER
Registration is a two-part process. This form alone does not guarantee a spot. Payment must be made upon completion of this form (a link to the site store will appear after submission of the form).
Be sure to pay for the correct number of participants in the payment screen.
Sponsor Information
This section should contain
your
information.
*
Indicates required field
Sponsor Name
*
First
Last
Enter your full name (first and last).
Phone Number
*
Provide a phone number at which you can be reached during the day (work phone preferred).
Work Email
*
Provide your official duty email here.
Building Number
*
Provide on-post building number or street address.
Category
*
Active Military
DoD Civilian
DoD Contractor
Other
Select the category that best applies to your position here at Picatinny Arsenal.
Relationship to Youth Participant(s)
*
Parent/Step-parent
Grandparent
Aunt/Uncle
Friend/Neighbor
Legal Guardian
Sibling
Select the relationship you have to the youth participant as is best defined by the available choices in the drop down menu.
Youth Participant Information
This section should contain information for
all
children who will be attending this event. Every field must be complete. For technical questions, please contact
[email protected]
.
Child #1
*
Name #1
*
First
Last
Provide the first and last name of Child #1.
Age
*
7
8
9
10
11
12
Select the age of Child #1.
Child #2
Name #2
*
First
Last
Provide the first and last name of Child #2.
Age
*
7
8
9
10
11
12
Select the age for Child #2
Child #3
Name #3
*
First
Last
Provide the first and last name of Child #3.
Age
*
7
8
9
10
11
12
Select the age of Child #3.
Child #4
Name #4
*
First
Last
Provide the first and last name of Child #4.
Age
*
7
8
9
10
11
12
Select the age of Child #4.
Payment Information
Registration fee is
$11.11
to be paid by you.
No cash payment will be accepted.
A link to provide payment will be provided once this registration form is submitted. If you complete this form but do not provide payment, you will risk losing your spot(s) for the event.
Registration is a two-part process. This form alone does not guarantee a spot. Payment must be made to complete registration.
Authorization and Release
I authorize Picatinny Arsenal and volunteers with the event to take/use photographs of the youth participant(s) identified in the form, above. These photographs may be portrayed in print and electronic media and will depict the youth participant as an attendee of the 2024 Bring Your Child to Work Day and/or Introduce a Teen to Engineering programs.
In the event of an emergency, I authorize the event volunteers to act for me, according to their best judgement, in any emergency requiring immediate medical attention. I acknowledge that the volunteers will attempt to contact me, if possible, and it is my responsibility to respond accordingly. I acknowledge that should my child have any life threatening conditions that require any medication, tools, or other devices, they are equipped appropriately.
By typing my name in the field below and submitting this form, I hereby authorize my consent and agreement to the terms outlined herein.
Name (Represents Legal Signature)
*
First
Last
Submit
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