NOMA Louisiana - Baton Rouge 2025 Project Pipeline Student Registration Form

Student #2 Name*

First NameLast Name
Student #2 Gender*
Student #2 Race*
Student #2 Email*
example@example.com
Student #2 School*
Student #2 Age*
Student #2 Grade Level in Fall 2025*
Student #2 Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Student #2 T-Shirt Size*
Student #2 Dietary Restrictions
Has student #2 participated in Project Pipeline before? If yes, what year(s)?*
Documentation As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*

Student #3 Name*

First NameLast Name
Student #3 Gender*
Student #3 Race*
Student #3 Email*
example@example.com
Student #3 School*
Student #3 Age*
Student #3 Grade Level in Fall 2025*
Student #3 Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Student #3 T-Shirt Size*
Student #3 Dietary Restrictions
Has student #3 participated in Project Pipeline before? If yes, what year(s)?*
Documentation As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*

Student #4 Name*

First NameLast Name
Student #4 Gender*
Student #4 Race*
Student #4 Email*
example@example.com
Student #4 School*
Student #4 Age*
Student #4 Grade Level in Fall 2025*
Student #4 Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Student #4 T-Shirt Size*
Student #4 Dietary Restrictions
Has student #4 participated in Project Pipeline before? If yes, what year(s)?*
Documentation As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*

Student #5 Name*

First NameLast Name
Student #5 Gender*
Student #5 Race*
Student #5 Email*
example@example.com
Student #5 School*
Student #5 Age*
Student #5 Grade Level in Fall 2025*
Student #5 Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Student #5 T-Shirt Size*
Student #5 Dietary Restrictions
Has student #5 participated in Project Pipeline before? If yes, what year(s)?*
Documentation As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*

Student #6 Name*

First NameLast Name
Student #6 Gender*
Student #6 Race*
Student #6 Email*
example@example.com
Student #6 School*
Student #6 Age*
Student #6 Grade Level in Fall 2025*
Student #6 Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Student #6 T-Shirt Size*
Student #6 Dietary Restrictions
Has student #6 participated in Project Pipeline before? If yes, what year(s)?*
Documentation As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*

Student #7 Name*

First NameLast Name
Student #7 Gender*
Student #7 Race*
Student #7 Email*
example@example.com
Student #7 School*
Student #7 Age*
Student #7 Grade Level in Fall 2025*
Student #7 Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Student #7 T-Shirt Size*
Student #7 Dietary Restrictions
Has student #7 participated in Project Pipeline before? If yes, what year(s)?*
Documentation As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*

Student #8 Name*

First NameLast Name
Student #8 Gender*
Student #8 Race*
Student #8 Email*
example@example.com
Student #8 School*
Student #8 Age*
Student #8 Grade Level in Fall 2025*
Student #8 Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Student #8 T-Shirt Size*
Student #8 Dietary Restrictions
Has student #8 participated in Project Pipeline before? If yes, what year(s)?*
Documentation As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*

Student #9 Name*

First NameLast Name
Student #9 Gender*
Student #9 Race*
Student #9 Email*
example@example.com
Student #9 School*
Student #9 Age*
Student #9 Grade Level in Fall 2025*
Student #9 Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Student #9 T-Shirt Size*
Student #9 Dietary Restrictions
Has student #9 participated in Project Pipeline before? If yes, what year(s)?*
Documentation As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*

Student #10 Name*

First NameLast Name
Student #10 Gender*
Student #10 Race*
Student #10 Email*
example@example.com
Student #10 School*
Student #10 Age*
Student #10 Grade Level in Fall 2025*
Student #10 Interests

ArchitectureSocial JusticeArtMathEnvironmentMusicPolitics
Student #10 T-Shirt Size*
Student #10 Dietary Restrictions
Has student #10 participated in Project Pipeline before? If yes, what year(s)?*
Documentation As a parent or guardian of this student, I hereby consent to the use of photographs/videos taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources) as well as survey information for camp reports and documentation. I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.
Information Release*

Yes, I give consent to use my child's information for camp purposes.No, I do not give consent to use my child's information.
How did you hear about Project Pipeline?*
Should be Empty:

Parent/Guardian Info

Student Info