The University of West Florida
Department of Chemistry
"Fun with Science" Contact Information

Note: ALL FIELDS MUST BE COMPLETED, UNLESS DESIGNATED OPTIONAL.  Each student must be registered separately.

Names of Parent(s)/Guardian(s):

1:

2: Optional

Home Address: E-mail:

City: State: Zip Code:

Home Telephone: Cell Phone:

________________________________________________________________

Contact in Case of Emergency:

Phone Number:

Relationship:

________________________________________________________________

Activity Sign-Up

Each session has an enrollment capacity based on the location and experiments. It is
listed directly next to the sessions below. Participants are only allowed to sign up for one
session for each day.

Please be sure to read and sign the Waiver Form. All students must have a waiver form on file in order to participate in the sessions.  Please submit the form by Friday, March 20 to Cindy Williams (fax 850-474-2621 or cwilliam@uwf.edu). If you have already submitted the waiver form, you DO NOT need to submit the form again.