If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required STUDENT REGISTRATION FORM ADVENTURE IN HIGH TECHNOLOGY NOTE TO SPONSORING CLUB: Complete this form and return it to us by October 5, 2016. Sponsoring Rotary Club Name: * First Name: * Last Name: * Address * City * Province * Postal Code * Email * Phone * Age Sex Grade What is your T-Shirt Size: * SMLXLXXL Emergency Contact Name: * Emergency Telephone: * Allergies (if any): Special Diet (if required): Foods that must be avoided: How are you Traveling by: AirRailBusCar Arrival Time on Sunday, October 16, 2016: Departure Time on Thursday, October 20, 2016 Note: The Program finishes Thursday, October 20, 2016 @ 3:30 p.m. Plan to participate in the whole program. Your sponsoring Rotary Club will make travel arrangements with you. I agree to abide by the rules of the Adventure program and my host family AND I understand that I may not drive during my stay in Ottawa.