BROS (Boys Reaching for Opportunity in Science) 2019 Application

The Des Moines University Pediatrics Club and Community Relations Department invite boys in grades 2-6 to Boys Reaching for Opportunity in Science, a FREE event designed to expose and inspire students to consider careers in health care and science. Boys will experience a variety of hands-on workshops including: 

> ANATOMY | See how things like smoking can hurt your lungs and understand how a brain works. 

> MICROBIOLOGY | Use a microscope and get a close look at the bacteria that cause common illnesses. 

> SIMULATION | Experience a simulated emergency room. 

> PODIATRY | We’ll look at the structure of the foot and participate in a casting or taping activity. 

> SURGERY | Learn how to scrub in for surgery and put on surgical gowns and gloves in our mock operating room. 

> PHYSICAL THERAPY | Get moving and see how the body system responds. 

> NUTRITION | Ride a blender bike and see how to plan a balanced diet. 

> SPORTS MEDICINE | Discover how to care for athletes before, during, and after games. 

Saturday, March 2 at Des Moines University Student Education Center 

Breakfast and lunch provided 

7:15-8 a.m. Drop off period 

8:30 a.m.-12:30 p.m. Boys rotate to a handful of more than a dozen exciting stations in small groups 

12.30pm Lunch and Keynote

1pm Pick up

Please apply below. IF YOUR APPLICANT IS SELECTED TO ATTEND you will be contacted so you are aware they are accepted. Please direct any questions to Hanna de Geest hanna.degeest@dmu.edu :) We are looking forward to hosting your amazing boys! 

Your First Name
Your Last Name
Email
Is your son/the applicant a student in Des Moines Public Schools?
Which elementary/middle school does your son/the applicant attend?
School contact e-mail:
What grade is the student in? (must be in either 2nd, 3rd, 4th, 5th, or 6th grade)
Is the student a son of DMU faculty or staff?
Name of Student (First)
Name of Student (Last) 
Does the student have any medical condition we need to be aware of (e.g. food allergy)? Please describe:
What is the student's t-shirt size?
Name of Parent or Guardian (First)
Name of Parent or Guardian (Last)
Parent or Guardian Phone Number
Parent or Guardian Email Address
As parent/guardian, if the applicant is selected, I consent to their participation in B.R.O.S.
EMERGENCY PROCEDURE: Should an urgent health matter arise, it is our practice to call 911. After this we will attempt to reach emergency contact via phone. Please initial if you understand and agree to these terms. 
Emergency phone number for day of event: 
DROP OFF/PICK UP PROCEDURE: A parent/guardian or authorized adult must drop off and pick up the participant at the event. Please identify the individual that will be dropping the participant off on the morning of March 2nd: 
What is this individuals relationship to the participant?
Please identify the individual that will be picking the participant up:
What is this individuals relationship to the participant?
CONSENT FOR MEDIA: I consent and authorize Des Moines University and its agents to take photographs or video of the participant in connection with these activities. DMU may use any such materials as the program deems necessary in the furtherance of its services or education. I authorize these images without compensation to me or the participant. All photographs, prints and digital reproductions shall be the sole property of DMU. Please initial if you understand and agree: 
How did you hear about this program OR who referred you?