Please fill out the following form:

First Name	*REQ
Last Name	*REQ
School Name	*REQ
E-mail	*REQ
Student Address	*REQ
Address (cont.)
City	*REQ
State	*REQ	Zip	*REQ
Student Phone	*REQ
Emergency Contact	*REQ
Emergency Phone	*REQ
School Contact	*REQ
School Contact's Phone/E-mail	*REQ
Student ID
Grade:	*REQ	Gender: M/F	*REQ

y/n *REQ IMPORTANT: I have completely filled out this form, printed it and will bring it with me to the event. I understand I will not be allowed to attend the event unless accompanied by this form with written parental/guardian signature.
PERMISSION –  LIABILITY- MEDIA RELEASE AGREEMENT
The undersigned student is participating in the Intel Career Day. By signing below the student and parent/guardian acknowledge understanding that Intel Corp and the STW have no liability for this activity. The undersigned agree that each participant is responsible for his/her own safety and agree not to look to Intel Corp, STW, or other involved parties with regard to liability for any claims related to participation in the Intel Career Day activities. Furthermore the student agrees to attend and participate fully in the entire program. It is understood that this is a learning event and the students agree to conduct themselves appropriately as representatives of their school. By signing below you confirm that you have read, understand, & agree to ALL of the above.  You give permission to be photographed at the event.
Parent Signature: _____________________________Student Signature: _________________________________

Official Use Only: I  ___________, on ______day of March, 2010, hereby agree and accept full responsibility for the constant supervision of all students in my company while on INTEL property and premises.
Signature of Employee________________ Department/Extension_________________