Student Attendee Information
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
School Name
(Required)
Grade
(Required)
9th Grade
10th Grade
11th Grade
12th Grade
Are you under 18 years old?
(Required)
Yes
No
Dietary Information
Do you have any dietary restrictions?
(Required)
None
Allergy
Vegetarian
Vegan
Gluten-Free
Other
Please specify any other dietary restrictions or allergies.
Media Consent
Please read carefully before signing. We want to use your name, picture, and voice in photos and videos. These will be used to show what we do at the GCSADVHT. What you're saying YES to: We can use your name, picture, and voice in photos and videos. We can use these for a long time, even after you're done with the GCSADVHT. We won't pay you for this. You can change your mind: You can decide if you don't want us to use your name, picture, or voice. Just let us know by emailing us at gcsadvht@mass.gov.
Do you consent to the information listed above?
(Required)
Yes
No
Parent/Guardian Information
Parent/Guardian Full Name
(Required)
First
Last
Parent/Guardian Email
(Required)
Parent/Guardian Phone
(Required)
Emergency Contact Name (if different than Parent/Guardian)
Name
First
Last
Emergency Contact Phone Number (if different than Parent/Guardian)
Chaperone
Will an adult chaperone from your school or organization be attending the conference with you?
Yes
No
If yes, what is their name?
First
Last
If yes, what is their email?