Ask A Scientist Permission Form
Thank you for your interest in the next installment of our Ask a Scientist Series!

During the current public health emergency, Yale GradSWE is offering your child the opportunity to participate in an Ask a Scientist event on May 26, 2020 using Zoom.  If you would like your child to participate in this program, please complete the form below. Program staff will copy you on email or text communications with your child, and your child will not be allowed to participate in the program if you do not provide your email address and cell phone number below.

If you are over 18, then you can also fill out this form for yourself.

**Only those who have filled out this form will receive the Zoom link.**
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Email *
Contact number *
Participant's Full Name (First and Last) *
Participant's Birthdate *
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Please provide the username associated with the Zoom account that you/your child will be accessing the call with below.
We will be kicking people off of the Zoom call if they have not filled out this form.
Zoom Username: *
Yale does not allow persons under the age of 18 to participate in online programming without the permission of a parent or guardian. By writing your full name here, you agree that your child may participate in the program described above and give permission for program staff to communicate with your child by video link or text based-messaging (through the Zoom interface). Video and audio will be disabled for all participants, though your child will be able to interact with us (but not other participants) through the chat.
Parent/Guardian Signature *
Date Form Signed *
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Do you have any questions for us?
This information is optional, but helps us understand our audience and know what communities we are reaching.
Where will you/your child be calling from? (city, state/province, country)
What school does your child attend?
A copy of your responses will be emailed to the address you provided.
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