MakeHERspace Inc. Parent/Guardian Consent Form for MinorsΔ Step 1Step 2Step 3Step 4Step 5MakeHERspace Inc.Parent/Guardian Consent Form for MinorsThis form must be completed and signed by a parent or legal guardian for any participant under the age of 18.PreviousNext1. Minor Participant InformationPlease provide details about the minor participating in the program.First NameLast NameDate of BirthAgeSchoolGrade LevelPreviousNext2. Parent/Guardian InformationPlease provide your contact information as the legal guardian.First NameLast NameRelationship to MinorPhone NumberEmail AddressHome AddressAddress Line 1Address Line 2CityStateZIP CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePreviousNext3. Program Participation ConsentI, the undersigned parent/legal guardian, give permission for my child to participate in MakeHERspace Inc. programs, including but not limited to: STEM workshops, Camps, Hackathons, Conferences, Community events, and Makerspace activities. I understand that participation may involve hands-on activities, tools, technology, and group collaboration.4. Emergency Medical AuthorizationIn the event of an emergency, I authorize MakeHERspace staff to: Obtain emergency medical treatment for my child; Contact emergency services if necessary; Contact me or the emergency contact listed below as soon as possible.Emergency Contact NameEmergency Contact Phone Number5. Medical & Allergy InformationPreviousNext6. Liability AcknowledgmentI understand that while MakeHERspace Inc. takes all reasonable precautions for safety, participation in programs involves inherent risks. I agree to release and hold harmless MakeHERspace Inc., its staff, volunteers, partners, and affiliates from any liability related to injury, loss, or damage that may occur during participation, except in cases of gross negligence or intentional misconduct.7. Photo & Media Release (Optional) I give permission I do NOT give permission8. Transportation Authorization (If applicable) I authorize I do not authorize9. Parent/Guardian AgreementBy signing below, I confirm that I am the legal guardian of the minor listed above and that all information provided is accurate.Parent/Guardian Name (Print)Signature (Type Name)Date Previous Submit Form
