Youth Robotics Club Agreement
Register for the club, provide essential information, and review the participation agreement.
Participant Full Name
*
First Name
Last Name
Participant Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Participant Email Address
*
example@example.com
Participant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does the participant have any allergies or medical conditions we should be aware of? If yes, please specify.
Agreement to Club Rules and Code of Conduct
*
I have read and agree to abide by the Youth Robotics Club rules and code of conduct.
Photo/Media Release Consent: Do you grant permission for the participant to be photographed or recorded during club activities for promotional or educational purposes?
*
Yes, I grant permission.
No, I do not grant permission.
Parent/Guardian Signature (required for participants under 18)
*
Submit Agreement
Submit Agreement
Should be Empty: