Event Coordinator Registration These are instructions to fill out this form. Student Information Form Name * First and Last School Name * Date of Birth * (format mm/dd/yyyy) Gender * Male Female Gender Neutral Graduation Year * 2019 2020 2021 2022 2023 2024 2025 2026 2027 Mailing Address * City * Zip Code * County * Beaver Box Elder Cache Carbon Daggett Davis Duchesne Emery Garfield Grand Iron Juab Kane Millard Morgan Piute Rich Salt Lake Sanpete Sevier Summit Tooele Uintah Utah Wasatch Washington Wayne Weber Email * Phone * format (xxx) xxx-xxxx Ethnic Origin * Caucasian Latina/o or Hispanic American Indian or Native Alaskan Black or African American Asian American Native Hawaiian or Pacific Islander (choose all that apply) Have you previously attended the State Science Olympiad tournament before? * No 2018 2017 2016 2015 2014 2013 2012 2011 (Click all that apply) Will you need any special accomodations during the competition? * Yes No If yes, please list any and all accomodations you will need: Please list any medical problems that you may have in the event you should need emergency medical care (for example, allergic reactions, heart problems, etc.) * Media Release: I have read and hereby consent to the terms of the Media Release as described here. * Yes Student Information: I have read and hereby consent to the terms of the release of Student Information as described here. * Yes Science Olympiad Code of Ethics: I have read and hereby consent to the terms on the National Science Olympiad website as described here. * Yes U of U Liability Form: I will download and complete the liability form and have my coach email it to firstname.lastname@example.org link is: here. * Yes Student Signature * By typing your name, you are signing this agreement electronically. Parent/Guardian Signature * By typing your name, you are signing this agreement electronically.