Danbury Robotics Summer Camp Registration
Summer Robotics Program Registration
Email address *
PLEASE NOTE: Filling out this form does NOT guarantee participation in the program *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Age *
Your answer
Student is *
Student grade in upcoming academic year *
Your answer
Student Town *
If you checked other please type answer here if not type N/A *
Your answer
Does Student need any accommodations or special needs? *
If Yes to the above question, please explain.
Your answer
Does Student have a Danbury Library card *
If Yes, What is Students Library Card Number, if no please consider applying for one. If no please type N/A *
Your answer
Parents/Guardians First Name *
Your answer
Parent/Guardians Last Name *
Your answer
Parents/Guardians cell phone numbers *
Your answer
Parents/Guardians Home number *
Your answer
Does Parent/Gaurdian have a Danbury Library Card *
If yes what is number, if no, please consider applying for one. If no type in N/A
Emergency Contact, Name and telephone numbers other than Parent/Gaurdian *
Your answer
Emergency contact number *
Your answer
Would you like to provide student email address, if so please provide. It is not required .
Your answer
Would you like to provide student cell phone number, if so please provide. It is not required.
Emergency Contact Relationship to Student *
Your answer
By submitting this form, you acknowledge that you have received a copy of the "Consent and Release" form and you agree to all of its terms. You must sign a hard copy in order for your child to participate in the program. A copy is also located on our websites: www.danburyrobotics.org and www.ler8699.org *
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