STUDENT REGISTRATION FORM
First Name Home Phone
Last Name Male/Female
Address E-Mail address
City Teacher/Sponsor
State Zip School Name
Grade Select one Classification below depending on your grade.
Classification 6-8 Classification 9-12
Title of Exhibit
Briefly explain your exhibit:
My exhibit requires:
    Electrical Outlet

The following statements must be signed before approval of entry can be given:

I certify that this exhibit has not been entered in a previous Reading Berks science and Engineering Fair by myself or anyone else, and that the exhibit is my own work: 

Signature of Exhibitor:  ________________________

I certify that to the best of my knowledge, this exhibit is the work of the student whose signature appears above:

Signature of Sponsoring Teacher: _______________

I hereby release the Reading-Berks Science and Engineering Fair and the Exhibit Hall from any liability for Property damage or personal injury in conjunction with the above exhibit:

Signature of Parent or Guardian:  ________________