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Vex IQ Summer Robotics Camp (Paragould)
Please complete this form to begin your registration. 

Registration is only complete once payment of $75 is received in full.  Payments cannot be made online.  

Payments by credit card may be submitted by phone at 870-248-4180.  If there is no answer, please leave a message and we will return your call.  

Registration deadline is Wednesday, July 10.

The Camp will be held July 22 - 25 from 12:00 - 4:00 p.m. 

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Email *
Student's First Name *
Student's Preferred Name
Middle Name *
Last Name *
Parent's Name(s)
Mailing Address  
(Example: 1234 Test Way)
 *
Mailing Address 
(Example: Pocahontas, AR 72455)
 *
Primary Emergency Contact (Name & Phone Number)
If Primary Emergency Contact is at work, what is the name of the business?
Alternate Emergency Contact (Name & Phone Number)
If Alternate Emergency Contact is at work, what is the name of the business?
Entering Grade for School Year 2024/2025 *
What School District Does Student Attend?
Student's Gender
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Child's T-Shirt Size
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What is the student's experience level with Robotics?
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Please list any special needs your child may have (including allergies to food, disabilities, etc.)
Please list those (other than parents and contacts already listed above) who have permission to pick up your child from BRTC Vex IQ Robotics Camp. Please do not send anyone to pick up your child who is not listed without notifying us in advance. A photo ID must be shown before check-out.  Disclaimer: By registering for this class, you acknowledge that photographs and videos may be taken during participation, and they may be used in BRTC publications as well as area media.  
A parent or guardian will be required to read and sign Parent's Permission Form after payment is received. 

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