Request edit access
Artifice Robotics After School Registration - Ray School (Fall 2018)
For a complete list of offerings see https://goo.gl/5XYNxG. This form is only for Fall robotics class registration with Artifice.

Please pay Artifice directly. Payments should NOT be made to Ray School. Please do not leave any payments at the front desk:

Program cost is $60 for Fall registration for both Beginner and Advanced Classes for the Fall quarter.

Payments can be made online with our PayPal account: www.artificechicago.org/donate.html.

*** On the PayPal site, under "Add special instructions to the seller," please write the student's name so that we can keep track of who paid for which student. If you have any questions about payment, you can contact accounting@artificechicago.org.

Checks may also be made out to "Artifice NFP".

For questions, please contact Lawson Lloyd at lawsontlloyd@gmail.com.

Student Name *
Your answer
Teacher Name *
Grade *
Required
Robitics -- UofC Artifice *
To register select which class below. Grades 4th-8th - Wednesdays OR Thursdays (Sept 12 - Dec 13) - $60 (10 OR 11 classes), 4:00-5:00pm.
Parent name *
Your answer
Parent / Guardian Email *
Primary e-mail. Program teachers communicate mainly through e-mail; please ensure that you have a working e-mail account.
Your answer
Parent / Guardian Phone *
Your answer
Alternate contact Name *
Your answer
Alternate contact Phone *
Your answer
Pick-Up Information *
Pick up is by the Main Entrance and must occur within 10 minutes of class dismissal.
Please provide the Names of adults that may pick up the child. *
By answering, I understand that identification at the time of pick up will be required.
Your answer
Media Consent *
I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs or movies of the Student named above. I also grant Ray School and its partners the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media. I also hereby release the Chicago Public Schools and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above. I understand that media consent is not required for program participation.
Participation Consent *
Next
Never submit passwords through Google Forms.
This form was created inside of The University of Chicago. Report Abuse - Terms of Service - Additional Terms