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2. Student First Name*
3. Student Last Name*
5. Parent/Guardian First Name*
6. Parent/Guardian Last Name*
8. Parent/Guardian Phone Number*
9. Parent/Guardian Email Address*
11. Student Age*
12. Student Grade*
14. Will student need a computer?*
    -- Select One --YesNo

    Will your student need a computer provided by the library? These computers are limited and reserved only for those without access to a personal computer.
16. Parent/Guardian Electronic Signature Agreement*

    I, parent/guardian, acknowledge the Chelsea Public Library Unattended Child Policy and understand that I am not to leave the building while my child is in coding club if they are under the age of 12 years old. Please sign by entering your full name. Please read over a copy of the Unattended Child Policy which is located on the library home web page under "Library Policies"

    1. I agree.
18. Parent/Guardian Electronic Signature*
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field