2017-2018 Danbury Robotics Application
Robotics application AKOMA Foundation, Inc. d/b/a Danbury Robotics, Danbury LEGO Robotics, League of Extraordinary Roboticists et. al.
Email address
Please Note* Before beginning this application please go to the same web-site and read the Consent and Release form. All participants are required to sign the Consent and Release form in order to participate. If it is not completed your application will NOT be considered!
By Starting and completing this application, you are acknowledging that you have read the Consent and Release form located on the same website as this Robotics Application form, for AKOMA Foundation, Inc., d/b/a Danbury Robotics, Danbury LEGO Robotics, which encompasses, but is not limited to all of our teams which participate in FIRST programs and FIRST events such as FLL jr, FLL, FTC & FRC and any and all other events we participate in, including but not limited to events within FIRST and outside of FIRST, including but not limited to community service and outreach events, social outing events, and any and all other events through AKOMA Foundation d/b/a Danbury Robotics, Danbury LEGO Robotics And its subsidiaries and partnerships etc.,.
Please Note* Filling out an Application does NOT guarantee placement on a team. All applications are due by July 1st. Notifications will be made via email by July 5th, so please make sure to type in the correct email address. Refunds will ONLY be issued if prospective team member is NOT placed on a team, less the $10 non-refundable application fee.
Please check that you understand and agree
Required
Fees: **Non-refundable $10 application fee** plus registration fees: FLLJr $200 FLL $350, FTC $500 (year-round participation), FLL&FTC combo $675
Financial Assistance MAY be available. see below. Sibling discount deduct $50 - Fees are for regular season, two t-shirts and 1 qualifying event only! Post season events i.e. State Championship, World Championship will require an additional fee ($100 each for FTC, $75 each for FLL). You will receive additional details once you are confirmed as a team member at the Parent/Team member orientation. Deduct $10 if you are a previous team member and already have a community service shirt and do not want another.
Please check that you understand and agree
Required
Please note even if applying for financial assistance, you must still pay a $10 non-refundable application fee.
Required
Applications will not be considered without complete payment, however if you need financial assistance, please note it at the bottom of the form, we MAY be able to help but again, you are still required to pay the $10 non-refundable application fee, even if requesting financial assistance.
Please check that you understand and agree
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Danbury Robotics has a code of conduct - Please read and please read to prospective team member: CODE OF CONDUCT: Any verbal, physical, threatening, bullying, misconduct, consistent disruption, behavior or repeated unexcused absences, etc., may result in termination from the AKOMA/DLR/DR programs and the assigned team at the discretion of the coach without any refund of the team fee. In order to participate, myself and my child must agree to the terms of the Code of Conduct. By checking yes below.
If you agree to the terms above, please begin the application.
We understand that WE, (Yes, the parents too!) must follow FIRST's Core values and Youth Protection Policies (including but not limited to acting with "gracious professionalism" AT ALL TIMES (i.e. treating others with respect, good sportsmanship, no tantrums, no yelling, no bad words, no fighting, no hitting, no name calling, etc., and follow safety rules. (see youth protection at www.usfirst.org website) failure to follow the policies may result in termination from the team and/or not being asked to return to a team in the future.
Prospective Team Member First Name
Your answer
Prospective Team Member Last Name
Your answer
Prospective Team Member Date of Birth
Your answer
What is grade of prospective team member?
Prospective Team Member mobile number (if team member does not have a number or you prefer not to answer, please type none)
Your answer
Team member email (this is where we will contact you, please proof read to make sure this is input correctly) (if team member does not have an email or you prefer not to provide it, please type none)
Your answer
Prospective Team Member Gender
Ethnicity* choose all that apply
If you checked Other, what is your ethnicity. (If you didn't check type n/a.)
Your answer
Prospective Team Member resides in what town?
If you checked other above, from what town (if not type n/a)
Your answer
What school will Prospective Team Member attend in the upcoming fall
Your answer
Prospective Team Member Home Address
Your answer
Prospective Team Member Home Telephone No.
Your answer
What program is Prospective Team Member applying for
Required
Are there any accommodations needed or learning differences, etc.,. that we should be made aware of concerning your child? This information may help us to understand and serve your child better?
Required
If you answered yes to the above questions, please explain further, (note we have a non-discrimination policy) if you didn't check please type n/a
Your answer
Does your child have any food allergies or any other allergies that we should be aware of?
If you answered yes to the above question, please explain further - if not please type n/a
Your answer
What is the main reason for applying?
Your answer
What does the Prospective Team member hope to gain from the program?
Your answer
What does the Parent/guardian hope that their child gains from the program?
Your answer
Tell us what other activities that the Prospective Team member participates in
Your answer
Parent/Guardian No. 1 Primary Contact ~ First and Last Name
Your answer
Parent/Guardian No. 1 mobile number
Your answer
Parent/Guardian No. 1 email (this is where we will contact you, please proof read to make sure this is input correctly)
Your answer
Parent/Guardian No. 1 is Team Members
If you selected Guardian, what is your relationship to Team member (please put n/a if you did not select guardian)
Your answer
Parent/Guardian No. 2 Secondary Contact ~ First and Last Name (if none, type none)
Your answer
Parent/Guardian No. 2 mobile number (if none type none)
Your answer
Parent/Guardian No. 2 is Team Members
If you selected Guardian, what is your relationship to Team member (please put n/a if you did not select guardian)
Your answer
Parent/Guardian Address if different from Prospective Team member (if not please type No)
Your answer
Parent/Guardian No. 2 email (this is where we will contact you, please proof read to make sure this is input correctly - if none, type none)
Your answer
Parent/Guardian No. 1 Occupation
Your answer
Parent/Guardian No. 2 Occupation (if none for above answer type n/a)
Your answer
Danbury LEGO Robotics and Danbury Robotics are subsidiaries of AKOMA Foundation, Inc. all are non-for profit organizations. Currently they are parent volunteer organizations. Parents and volunteers are the most important part of the team. All parents are expected to assist and support the team and/or the Foundation in different ways. Lack of active parental involvement or positive support in team activities may result in the team member not being invited back to the team. Please select at least one parent duty function that you can help the team with.
Required
In order to volunteer for certain activities, you may be required to go through a background check due to FIRST's Safety program . Are you willing to go through a background check?
If you checked other, in terms of your volunteer ability, what were you thinking of? Please explain (if you didn't check other please type n/a)
Your answer
As you can see from the above volunteer opportunities, there are many roles on the team. Every team member may not have "hands on" the robot every meeting or the computer every meeting, especially during the first year on the team, but all team members are expected to participate in some designated capacity.
We understand that this is a year round sport and we will be required to participate at events throughout the year, even when the official robotics season is over. Failure to participate or follow any expectations listed or stated may jeopardize remaining on the team and/or being allowed to return to the team in the future.
Emergency Contact No. 1 Name, Number, Relationship to Team member
Your answer
Emergency Contact No. 2 Name, Number, Relationship to Team member
Your answer
This information is needed when we write grant applications. What is your total house hold income?
Does your child qualify or receive free or reduced lunch?
Do you or your child receive government assistance, like Husky, Snap, Wic, SSI, etc.,.
We understand that the team primarily uses team snap for team communications, including homework assignments that need to be completed!Please use team snap to alert the coaches as to your child's availability for events and to receive notices of upcoming events, messages and assignments from the coach and at times from team mates. Note: we may also use google classroom for collaborative work, etc.,. (you can always email the coaches privately if there is any issue you need to address privately)
Please make sure your child arrives by the time the meeting starts and after helping to clean up, leave when the meeting ends.
Submitting this application signifies that you are the Parent/Guardian of the prospective team member and are over the age of 18. You also agree that you have read and agree to the Consent and Release form located on the same website as this form, which includes but is not limited to, Liability Releases, Medical Releases and Photo/Video Releases, etc.,.
Submitting this application signifies that you are the Parent/Guardian of the prospective team member and are over the age of 18. You also agree that you have read and agree to the Consent and Release form located on the same website as this form, which includes but is not limited to, Liability Releases, Medical Releases and Photo/Video Releases, etc.,.
The responses in this application are truthful. If selected, my child and I will abide by the rules and expectations of the program and coaches and if we fail to, we may be terminated from the program without any refund.
I understand that once I submit payment, there will be no refunds unless my child is not selected to participate in the program. I also understand that submitting the application and payment does NOT guarantee my child a spot on the team! If my child does not get a spot on the team all monies except for the $10 non-refundable application fee, will be returned.
T-shirt size for Team member
Required
T-shirt size for Family member
Required
Jacket/Sweatshirt for Team Member(s)
Required
Jacket/Sweatshirt for Family Member(s)
Required
I also understand that space is limited on a team and because of this, other individuals will not be able to join a team. Once I submit a complete application and payment, if my child is selected, there will be no refunds at all, even if my child and I decide to quit the team.
Fees
Required
Total Amount Due and Submitted * please note if financial application will be submitted, application is located on website along with other forms. *Note you are still required to submit the $10 non-refundable application fee, even if applying for financial assistance.
Your answer
NEW THIS YEAR ... For Returning members only! If you are not a returning member type n/a. Do you have any suggestions for the upcoming season of what you would like to see change or what you would like to keep the same or any other suggestions so we can be a better organization. If none, type none.
Your answer
What is method of payment? **Please note application is not complete until full payment has been received. Only exception is if financial assistance application is pending. However, the $10 application fee must be paid for the financial assiance application to be considered.
Hungry after filling out this form? :) Head over to our website for information on our Applebee's pancake fundraiser on June 25!
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