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
Please complete the captcha before submitting the form.
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