January 2022 4-H Robotics Project Registration

$25.00

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Description

This is payment for registration for the 4-H robotics project that will take place January 2022.

4-H Robotics Registration Form
Student Information
Student Information
First
Last
Age student will be when program starts
Gender
Gender student identifies with
Student's Home Address
Student's Home Address
Address line 1
Address line 2
City
State/Province
Zip/Postal
Ethnicity. Please check one. This information is for federal grants and demographic information.
Legal Guardian Information
Legal Guardian Information
First Name
Last Name
Is legal guardian's address the same as the student's?
Address
Address
Address line 1
Address line 2
City
State/Province
Zip/Postal
Emergency Contact Name
Emergency Contact Name
First
Last
List any allergies your child has and please list the reactions to those allergies.
Does your child have an EpiPen?
Are they able to administer the EpiPen themselves?
Please list any special accommodations needed for your child/
Anything else we should know about your child?
PLEASE READ CAREFULLY. THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS.
I grant permission to use photographs of my minor child in print or online material designed for news, informational or educational purposes related to The Kaleidoscope Discovery Center. Legal Guardian