¥ 2009 ¥ To Families in Harlem ¥ Do NOT give us money until you get an official confirmation number!

 

 

 

We at The ChildrenÕs Storefront work with the Wireless Harlem Initiative to provide free computers to Harlem families with children in grades 4-12. The schedule for Tech Saturdays in 2009 is on our Web site of www.techsaturdays.org or you can call our phone of 212-427-7900 ext 333. To sign up, please return the information on this form by e-mail or fax or bring to the Front Office. We currently have over 100 people on the waiting list and select names via a lottery system out of a hat. Once you get your confirmation number, you will be asked to bring in or mail in the $20 within 7 days (cash or money order, no checks). We apologize for the delay in getting back to you via phone or traditional mail. All of us have full time jobs and are doing this on the side to help families in Harlem. The good news is that there will always be more Tech Saturdays and we hope to help out as many as we can.

 

 

 

Please direct questions to Steve Bergen, sbergen@cstorefront.org or leave your name, phone number and address on our Tech Saturday Phone which is 212-427-7900 ext 333. This form is posted on our www.techsaturdays.org Web site. If you have email, we prefer that method for signing up! Please try to send e-mail or have a friend do so for you!

 

 

 

¥ Full Name of the adult attending:_________________________________________________

 

 

 

¥ Full name of the child attending: _________________________________ Grade of child: ____

 

 

 

¥ Address:_____________________________________________________________________ Zip Code: ____________________________________________________________________

 

 

 

¥ Phone numbers: ________________________________________ Email (if available): _____

 

(we cannot call you if your cell phone blocks restricted calls)

 

 

 

Put initials in each blank below and return to the front office or mail to the attention of Steve Bergen at The ChildrenÕs Storefront, 70 East 129th Street, New York, NY 10035 (SW corner, next to BP Station)

 

 

 

___ Yes, I understand that The Children's Storefront and WHI have no responsibility for the upkeep of this free computer. I understand that WHI will help to try to find a way to get me Internet connected but there are no promises and that this will take time. I understand that any calls for tech help go to the WHI phone 866-586-0999, ext 1023.

 

___ Yes, I understand that it is our responsibility to ensure that my child is using safe and honest practices.

 

___ Yes, I understand that both my child and I must attend and we will have to help out for 30 minutes with the setup/breakdown.

 

___ Yes, I understand that some pictures and videos may be posted on the Web and give my permission accordingly

 

___ Yes, I understand that the workshop costs $20 but that the computer is free. I will wait until I get a confirmation number before giving the $20 by cash or money order within 7 days of getting a confrimation number.

 

___ Yes, I understand that the computer is heavy (50 lbs) but we will bring a shopping cart to get it home.

 

___ Yes, I voluntarily and knowingly agree to participate in The Children's Storefront's Tech Saturday program (the "program"). Therefore, I understand that it is my responsibility to determine whether I am capable of carrying, lifting and moving the computers and other equipment as part of my volunteer duties for the School. In the event that the Children Storefront and/or the Wireless Harlem Initiative, or any of its/their agents (collectively, referred to herein as the "School") is sued or named as defendants as a result of my voluntary participation in the program, except for any intentional acts of the School, I shall reimburse the School upon demand for, and shall otherwise defend, indemnify and hold harmless the School from and against, all losses, claims, damages, liabilities, costs and expenses (including, but not limited to, judgments, medical bills, costs, taxes, fees, penalties, interest and attorneys' fees) as incurred, based on or arising from or in connection with any such determination. I agree to make such reimbursement (or take other necessary action) no later than ten (10) business days following receipt of any demand made of me by the School.

 

 

Two Optional Extra Questions (ÒTech Saturday for BusinessesÓ and ÒTech Saturday for Young OnesÓ)

 

 

 

¥ Yes, I am interested in the Tech Saturday for Businesses. I am part of the business in Harlem called ____________________________ which is located at the address of ___________________________________________

 

¥ Yes, I am interested in the Tech Saturday for Young Ones (grades K-3) which will be held on March 7th, 2009. I have a Young One named ______________________ in grade ______.

 

 

 

 

Phone number for any tech questions once you get your computer: 866-586-0999, ext 1023