Step 1 of 3: Basic Information

Please fill in the following information for your child:

First Name
Last Name
Gender
Birthday (mm/dd/yyyy)
Are you eligible for reduced or free lunch at school?
School Name
Nominating Teacher
Teacher's Email Address
Teacher's Telephone Number
Home Phone (###-###-####)
Email Address
Select a Chapter
Parent/Guardian 1
Parent/Guardian 1 Phone/Cell (###-###-####)
Parent/Guardian 1 Email Address
Parent/Guardian 2
Parent/Guardian 2 Phone/Cell (###-###-####)
Parent/Guardian 2 Email Address
Address
City
State/Island
Zipcode/Postal Code
Insurance Company Name
Insurance Company Address
Plan #
Policy #
Policy Holder’s Name
Policy Holder’s Date of Birth
Relationship to Student/Participant
Address (if different than Home Address listed in Section 1)
City
State/Island
Zip/Postal Code
T-Shirt Size
Allergies/Dietary Restrictions
Are you interested in being a part of the Junior Mentor Program?

If you have (1) participated in an InnoWorks camp as a student in the past, and (2) are currently in high school, then you may apply to participate in the InnoWorks Junior Mentor Program.  

Junior Mentors will be assigned as a helper to a mentor or staff member during the summer program. Tasks assigned to Junior Mentors will include assisting in leading an InnoWorks student team as directed by a mentor, helping staff with preparing and testing activities and missions, and assisting in lecture demonstrations.

If you qualify and are interested in becoming an InnoWorks Junior Mentor and helping your younger InnoWorkers, please indicate below to receive the application form. 

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InnoWorks is a Winner of the 2007 BRICK Awards