PJAS Region 1B Presenter Registration Form

Date: 2/24/18

Time: 7:45AM – 12PM

Place: Souderton Area High School

625 Lower Rd, Souderton, PA 18964

Cost: $20.00 per student (checks payable to PJAS1B)

Online registration for all students and sponsors must be completed by Friday, January 12, 201 at 11:59 PM. Any student who registers after that time will not be entered in the competition.

Hard copy registration is Thursday January 18th from 4-6 pm in Mr. Helm's room A213 at Methacton High School (tenative). Please staple your completed 2018 PJAS Student Registration Form (this form) to the front of your protocol papers.

______M __ F

First Name (capitalize 1st letter) Last Name (capitalize 1st letter)Gender (circle one)

___1B__________

Region Grade Birth Date Years in PJAS

(6-12) (Including this year)

Student Address: ______

______Pa______

City State Zip

Primary Phone: ______

Student Email: ______

School Name: ______

Sponsor (teacher): ______

Project Title (Limited to 60 Characters)

Capitalize the first letter of MAJOR words.

______

______

Project Category: Check ONE

____ Biochemistry____ Behavioral/Psychology____ Biology general

____ Botany____ Chemistry____ Computer Science

____ Ecology____ Earth and Space____ Engineering

____ Mathematics____ Microbiology____ Physics

____ Zoology

2018

PJAS Region Presenter Permission Form

We certify that this research has been conducted by the student in accordance with the International Science and Engineering Fair rules as adopted by the Pennsylvania Junior Academy of Science. We further agree to accept the Judge’s evaluation of this research as final.

In consideration of the furtherance of your purpose, objectives, and work and in consideration of your permitting me to participate in the PJAS regional meeting and state meeting on behalf of myself, my heirs, executors, administrators and assigns, I hereby waive and release any and all rights for damages I may have against you, the school district, the Souderton Area School District, and the Pennsylvania State University as well as any other persons connected with the Pennsylvania Junior Academy of Science Regional Meeting and State Meeting, their heirs, executors, administrators and assigns for any and all injuries which I may suffer while taking part in the Pennsylvania Junior Academy of Science regional Meeting and State Meeting or as a results thereof.

Signature of Student ______Date ______

Signature of Parent ______Date ______

Signature of Sponsor ______Date ______

Note: This form may not be altered. The signatures of student, parent, and sponsor are required. If the permission form is missing, the student will not be allowed to compete.

Photo Release:

PJAS is making an effort to promote the positive achievements of our participants. We seek your permission for PJAS to take photographs of your child in connection with the PJAS Regional and State competitions and your authorization for PJAS to copyright, use, and publish the same in print and/or electronically. PJAS will not identify your child by name in the photographs.

_____ I give PJAS permission to photograph my child under the above guidelines.

_____ I request that PJAS does not photograph my child.

______Date ______

Parent’s Signature

2018