2010 Mississippi Science And Engineering Fairs Elementary Registration Form For Grades 1-6 (Page 3 of 5) in pdf

2010 Mississippi Science and Engineering Fairs

Elementary Registration Form for Grades 1-6

REGISTRATION DEADLINE FOR ALL REGIONS: FEBRUARY 19, 2010

_____________________________________________________________________________

Instructions: Complete ALL sections of this form. PRINT or TYPE all information. Submit this registration form, any other

required forms, and $10.00 registration fee for each student to the Local Science Fair Key Teacher by the deadline set by the

teacher. Each school must then submit all registration forms and ONE CHECK for all registration fees to the Regional

Director. Checks should be made payable to MSEF. If your region allows TEAM projects, fill out one registration form for

each student and STAPLE.

________________________________________________________________________________________________________________________

Section A: Check ONLY ONE category.

[ ] 0100 Behavioral & Social Sciences

[ ] 0600 Engineering, Computers, & Math

[ ] 0200 Biochemistry

[ ] 0700 Medicine & Health

[ ] 0300 Botany

[ ] 0800 Microbiology

[ ] 0400 Chemistry

[ ] 0900 Physics

[ ] 0500 Earth, Space, & Environmental Sciences

[ ] 1000 Zoology

__________________________________________________________________________________________

Section B: Title is limited to 80 spaces. Please print or type ALL information in this section.

Project Title: _________________________________________________________________________________________________

____________________________________________________________________________________________________________

Is this a continuation of a previous year's project? [ ] Yes [ ] No. If yes, how many years of work? ___________________________

Student Name_________________________________________________Age_____Grade_____Student Home Phone____________

Student Home Address______________________________________City_______________State_______Zip Code______________

School Name________________________________________________County________________Phone Number_______________

School Address____________________________________________City_______________State_______Zip Code______________

Adult Sponsor/Teacher____________________________________________________________________

__________________________________________________________________________________________

Section C: Registration Certifications:

(Registration will be VOIDED without proper signatures.)

Parent's Certification: Signature required for ALL Exhibitors. This is to certify that as the parent or legal guardian of the above indicated student, I

give my permission for his/her participation in the Mississippi Science and Engineering Fair program. I further certify that I release any and every

liability, claim, right of action of any kind or nature, which my child or legal representative may have for any and all bodily or personal injuries or

property damages or any other damages resulting therefrom, whether caused by negligence or other acts or missions or releases or otherwise which

might occur during participation in the MSEF programs, any host institution(s), any regional or state fair sponsor(s), or the representative(s) thereof,

and the management or owner(s) of any physical facility in which any fair is conducted.

Parent or Legal Guardian's Signature____________________________________________________________Date_______________________

____________________________________________________________________________________________________________

Key Teacher Certification: Signature required for all entries into Regional Fairs. I have reviewed the form(s) for both correctness and completeness.

I further certify that (1) this project follows all proper procedures involving humans and/or vertebrates, (2) that school officials pre-approved the

questionnaire(s) and that I and others in the school take full legal and ethical responsibility for both the questionnaire and its use in human research,

and (3) that the research behind the project and display represent the work of this student. I therefore certify this registration to be a complete,

authorized entry in the current year's Regional MSEF Fair.

Key Teacher's Name (please print)__________________________________________________________________________________________

Key Teacher's Signature______________________________________________________________________Date________________________

2010 Mississippi Science And Engineering Fairs Elementary Registration Form For Grades 1-6 Page 3

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