Keep Connecticut Cool Climate Change Challenge Registration

Please read the Keep Connecticut Cool rules before completing the registration form.

To be eligible to participate in the 2010-11 Keep Connecticut Cool Challenge, the adult coach of a team must complete and submit the registration form no later than March 1, 2011.

A separate registration form must be submitted for each team.

Please insure that the primary email address listed in the registration form is valid. This is the means by which official information from Keep Connecticut Cool will be communicated to all teams. The secondary email address may be that of a student team member or another adult who will have contact with the team. Information from Keep Connecticut Cool will also be sent to this email address.

The coach will receive official confirmation of the team's registration within two weeks of submitting this form. If you have not received confirmation within two weeks please send an email message to KOHLL@easternct.edu If you'd like to make a change to an existing team, please fill out this form.

Please fill out the form below (check all that apply).
Note: items marked with a * are required.

The Coach:
*First Name:
*Last Name:
*Title:
*School or Organization that I (and this team) are affiliated with:
*Email address:
*Email address(2):
Phone:
Street address:
*City:
State:
ZIP code:
School Type:	Elementary School Middle School High School
	I certify that I am a teacher or other employee of a school attended by at least one of the student team members, or a teacher at a home school attended by at least one of the student team members, or a professional staff member or official volunteer of a non profit organization, such as a Boys or Girls club, community center, church youth group, or similar organization, having among its purposes the education of students in grades 6 through 12, and that I am at least 18 years of age.
	I agree that I and the student(s) on this team, will abide, and be bound, by the Cool It! Rules and have the necessary organizational or parental permission to participate in Cool It!.
Teams:
Elementary School Middle School High School
Students: A team must have a least one and no more than 15 student members
Number of students in your team: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
name:  grade:  town:  school: Student 1: Student 2: Student 3: Student 4: Student 5:
Where did you first learn about Cool It!
	At school Through a local organization or participating science center At an event Through the media From a friend or colleague Other
	Please provide the name of the school, science center, organization, event or other means through which you first learned about Cool It!