Robotics Tech Camp Registration – Summit Church Texas

Student Name *

First

Last

Phone Number *

Last Grade Completed in School *

to Name pick

If you are a lady and would like to paint a tote bag instead of build a robot please select Yes.

Parent/Guardian Name *

First

Last

Address *

Email *

Phone Number *

Medical Information/Allergies *

Medical or other information we need to know. (please include any food allergies.) If none, say N/A

Emergency Contact 01 Name and Number *

Please include: First Name, Last Name, Phone Number

Emergency Contact 02 Name and Number

Please include: First Name, Last Name, Phone Number

Who may pick up your child at the end of each day? *

Please include: First Name, Last Name, Phone Number

May we have permission to use your child's photograph for the purpose of promotion? *