Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Background Check Consent *

I hereby authorize We Connect the Dots, Inc. (WCTD). to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist WCTD in collecting this information. Backgroundchecks.com has been secured as a third party vendor (consumer reporting agency) to assist WCTD in collecting and verifying information. I also am aware that records of arrests on pending charges and/or convictions are not an absolute bar to participation. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my position in a manner which is safe for WCTD students, employees, and other community members. If you consent to these terms please select "Yes" from the dropdown below. 

Yes, I agree

Photo Release Waiver *

Photo Release Waiver: I give my permission to participate in video and photos with regards to We Connect The Dots, Inc.(WCTD) while attending the WCTD programs or events. WCTD’s photographers may use pictures and video taken of me for professional promotional purposes related to We Connect The Dots, Inc. Including studio display, advertisements, web site, and portfolio.   WCTD’s press team may use and reproduce your name and/or quotations for promotion purposes related to WCTD’s Student Initiative, including publication on the World Wide Web, in the United States or elsewhere at any time.   I understand that I do not have any right to receive compensation or benefit in connection with this release, and I have no claims against We Connect the Dots, Inc. and its agents arising out of WCTDs and its agents use as described above.

Yes I agree

Educator Volunteering for CreatingSTEAM

Yes I am volunteering as an Educator

Yes I am joining as a one day visitor to the program

Volunteering for Code-a-thon 2018

Please select the location you are volunteering for.

Westbury, NY

Darby, PA

SANDUSKY COUNTY, OH