A Day in the Life of a Physics Major

STUDENT INFORMATION

Student's First Name

Student's Preferred Name

Student's Middle Name

Student's Last Name

Student's Personal Email Address
Please do not use a shared family email address or a school email address.

Student's Birthdate

I will be 18 years of age or older when attending this event

Yes, I will be 18 years old or older when attending this event.

No, I will not be 18 years old or older when attending this event.

Before proceeding, please note that if the student attending is under 18 years of age, a parent/guardian over the age of 18 must be in attendance with the student for the event.

How many people are you bringing with you? Please do not include yourself in this number.

Who will be accompanying you during A Day in the Life of a Physics Major (i.e. parents, siblings, friends, etc).

Mailing Address

Country

Street

City

Region

Postal Code

Mobile Phone Number

I consent to receive notifications from Virginia Tech Undergraduate Admissions. Reply STOP to unsubscribe. Msg & Data rates may apply. Standards of Use/Terms of Service

Yes

Year you will enter Virginia Tech:

When applied to Virginia Tech, how did you apply?

What is your current grade?

What institution did you most recently attend?

What high school did you/do you attend?

PARENT/GUARDIAN INFORMATION

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email Address

Parent/Guardian Mobile Phone
This should be the number to reach parent/guardian day of the event in case of emergency

The proceeding sections of this form is for parents/guardians to fill out.

ATTENDANCE PERMISSION

Before proceeding please note that during the Preview Day event, there will be some activities just for students and some just for parents/guardians. During these event, students will be separated from their parents/guardians. These activities include: attending a class, visiting a residential hall, and having lunch with current students.

I understand that during the event, I will be separated from my student at certain points. I give my permission for the participant named on this form to attend the designated VA Tech program. My student has permission to participate in all activities under the supervision of Preview Day Program Staff.

Yes, I accept and agree

No, I do not accept or agree

STUDENT HEALTH AND MEDICAL HISTORY

Please list any medical needs if any that we should be aware of (i.e. food allergies, non-food allergies, asthma, diabetes, heart condition, seizures/convulsions, other):

Please list any medical treatment devices your student has with them (i.e. EpiPen, specific medicine, inhaler, etc.):

I hereby give permission to the medical staff person selected by the event/activity director to order X-rays, routine tests and treatment for my child (or for myself if I am a participant over 18 years old) as medically necessary. I also give permission for the participant to receive over-the-counter medication as needed under the guidance of the medical staff person. I understand that all attempts will be made to notify parents/guardians of any serious injury or illness to their child. If I cannot be reached in an emergency, I hereby give permission to the medical staff person to hospitalize, secure proper treatment for, and to order injection and/or anesthesia and/or surgery for me/or the participant named on this form. This form may be photocopied for use outside of the event/activity location.

Yes, I accept and agree

No, I do not accept or agree

MEDIA RELEASE

For valuable consideration received, the undersigned hereby irrevocably consents to and authorizes the use by Virginia Polytechnic Institute and State University ("Virginia Tech") of the undersigned's name, image, voice and/or likeness as follows: Virginia Tech shall have the right to publish, re-publish, adapt, exhibit, perform, reproduce, edit, modify, make derivative works, distribute, display or otherwise use or re-use the undersigned's name, image, voice and/or likeness in connection with any product or service in all markets, media or technology now known or hereafter developed in perpetuity throughout the universe including advertising, promoting and merchandising the product or service. Virginia Tech may exercise any of these rights itself or through any successors, transferees, licensees, distributors or other parties, commercial or nonprofit.

Yes, I accept and agree

No, I do not accept or agree

During your visit, will you require assistance or accommodation due to a disability or injury?

Please explain in the field below.

If you would like, please use the space below to submit questions ahead of time.