First Name
Last Name
Date of Birth
Age
Email
Phone Number
Address
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone Number
Linked In Url
Instagram Url
Tick Tock Url
Which categories below do you feel best describe you? Select all that apply. *
White (e.g., European descent) Black (e.g. African, Afro-Caribbean, African-Canadian descent) Latino (Latin American, Hispanic descent) East Asian (e.g. Chinese, Korean, Japanese, Taiwanese descent) Central Asian (e.g. Afghans, Tajiks, Kazakhs, Uzbeks) Southeast Asian (e.g. Filipino, Vietnamese, Cambodian, Thai, Indonesian, or other Southeast Asian descent) South Asian (e.g. East Indian, Pakistani, Bangladeshi, Sri Lankan, Indo-Caribbean) Middle Eastern (Arab, Persian, West Asian descent, e.g. Afghan, Egyptian, Iranian, Lebanese, Turkish, Kurdish) Prefer not to say
Do you identify as a person with a disability? (Under the Accessible Canada Act, a disability is defined as any physical, mental, intellectual, cognitive, learning, communication, or sensory impairment, or functional limitation. It may be permanent, temporary, or episodic, visible or invisible, and when combined with a barrier, can limit full and equal participation in society.)
Yes No Prefer not to say
If yes, Institution Name
Field of study
If Yes, Job Title
Company/Organization
Please describe any relevant skills or areas of expertise (coding, design, sustainability, etc.):
Other (Please specify):
Why do you want to participate in the Future Innovators Hackathon?
What specific challenges or issues related to sustainable development are you most passionate about?
How do you believe your skills and experiences can contribute to addressing the goals of this hackathon?
Skills or tools you are interested in learning during the hackathon
If yes, please describe your previous experience
Do you have a project idea or topic you would like to work on during the hackathon? If yes, please describe it briefly:
What qualities do you value in a team member or mentor?
I yes please specify
If yes, please specify
Parent/Guardian Name
Parent/Guardian Phone Number
Parent/Guardian Email
By signing below, I confirm that I am the parent or legal guardian of the participant named above, and I give permission for them to participate in the Future Innovators Hackathon. I understand that I must also sign a separate Parental Consent Form and Liability Waiver for my child’s participation in the event.
Parent/Guardian Signature
Date
I, the undersigned, agree to the following terms and conditions:
Participant Signature:
Date
Bioloop Foundation may capture photos and videos during the event for promotional and archival purposes. By participating in the event, you consent to the use of your likeness, image, or video footage for promotional, marketing, and educational purposes.
By signing below, I agree that Bioloop Foundation may use photographs or video recordings of me for promotional purposes without any compensation.
Participant Signature
Date
By signing below, I give my consent for Bioloop Foundation to seek emergency medical care for me if necessary.
Participant Signature:
Date
All participants are expected to adhere to the Event Rules and Code of Conduct, which promote a safe, respectful, and inclusive environment for everyone. Violations of these rules may result in removal from the event.
By signing below, I acknowledge that I have read and understood the Event Rules and Code of Conduct and agree to comply.
Participant Signature
Date
If you have any additional questions or comments about the event, please provide them here:
Application Review Considerations:
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