Holiday Robotics Registration Form

Holiday Robotics Registration Form

Please fill in the form below.
Student Name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Which day(s) are you registering for?
Previous robotics experience?

YesNoOther
Parent/guardian name*
Full name
Parent phone number*
Parent E-mail*
Emergency contact *
Name and phone number
Allergies/medical issues
Consent
By submitting this form, parents and guardians confirm they have spoken to students about listening to student mentors and coaches and participating in lessons with grace and courtesy.

Parents/guardians agree to:
- authorise emergency medical treatment if needed.
- commit to paying registration fees. Participation is only guaranteed once payment has been made. A link to the payment gateway will appear once the form is submitted.
- ensure students are picked up promptly at the end of sessions.
- understand that sessions are being run by experienced parent and student volunteers and while endorsed by the school are NOT an official school or OOSH activity.
Permissions

I consent for photos and video images to be taken of my child which may be used in a variety of settings including media, website, print and other.
Comments or questions:
I am paying for:
prevnext( X )
Single day camp$70.00AUD

Both holiday camps (discounted)$120.00AUD

Total $0.00AUD
Once you click submit you will be redirected to PayPal to complete your payment (Credit Card or PayPal account accepted). Please send us a copy of your PayPal receipt as we will need payment to confirm your place.
Should be Empty:

Holiday Robotics Registration Form

Consent