Lakeshore Robotics Team
Student Contact Information
Student First Name *
Your answer
Student Last Name *
Your answer
Student Gender *
Student Grade Level *
Student Home Phone Number
Your answer
Student Cell Phone Number
Your answer
Student Email Address (checked regularly) *
Your answer
Parent 1 Contact Information
Parent 1 First Name *
Your answer
Parent 1 Last Name *
Your answer
Parent 1 Home Phone Number
Your answer
Parent 1 Cell Phone Number
Your answer
Parent 1 Work Phone Number
Your answer
Parent 1 Email Address (checked regularly) *
Your answer
Parent 2 Contact Information
Parent 2 First Name
Your answer
Parent 2 Last Name
Your answer
Parent 2 Home Phone Number
Your answer
Parent 2 Cell Phone Number
Your answer
Parent 2 Work Phone Number
Your answer
Parent 2 Email Address (checked regularly)
Your answer
Parental Involvement
How can you support the team? *
Yes
No
Food & Snacks
Chaperon
Build Practice Field Elements
Event Volunteer
Sponsor Team (monetary or in kind donation)
What areas are you comfortable to help as a mentor? *
Yes
No
Design
Build
Electrical
Programming
Website
Business/Marketing
Project Management
Authorization for Emergency Treatment and OTC Medication
I do hereby give Mr. Smith, Mr. Woodard, a team nurse, or a team mentor permission to sign an authorization form for emergency medical treatment for my student during any activities of the Lakeshore Robotics Team. I also recognize that Mr. Smith, Mr. Woodard, team nurses, team mentors, and Lakeshore Public Schools are not liable for any injury that may happen to my student during robotics-related activities. *
I give Mr. Smith, Mr. Woodard, a team nurse, or a team mentor permission to distribute over-the-counter (OTC) acetaminophen (i.e., Tylenol), ibuprofen (i.e., Motrin), or medication for upset stomach to my student if necessary. *
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