2018-2019 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 click on link below or 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! Please go to link below or website.
By Starting and completing this application, you are acknowledging that you have read the Consent and Release form located above and 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 FLL and FLLJR applications are due by August 1, 2018. FTC and FRC applications are due by September 1, 2018. (FTC and FRC programs are year around programs) Notifications will be made via email by mid -late August for FLLJR and FLL and before September 9 for FTC and FRC. so please make sure to type in the correct email address. Membership on our teams is by invitation only! You can apply for the team but only when you receive written confirmation that you have been selected to join the team, will you be on the team. Prospective Team members may be interviewed before an offer is made. 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
Meeting Days, Times and Locations: FLLJR-Sunday’s 1:15-2:15 pm at the Danbury Public Library ; FLL/FTC/FRC - Sunday’s 2:30-4:30 pm at the Danbury Public Library; FTC Thursday’s 6-8 pm place TBD; FRC Wednesday’s 6-8 pm at Workspace in Bethel. For all programs, this is the minimum schedule. We may add additional days as necessary. For example, FRC during build season, which starts in January, we may meet every day; during the week from 6pm until..and on the weekends... all day.
Fees: **Non-refundable $10 application fee** plus registration fees: FLLJr $200 FLL $350, FTC $500, FRC $800. The fees cover the period beginning Sunday September 9, 2018 for all teams to November 3, 2018 for FLLJR; November 17, 2018 for FLL and December 15, 2018 for FTC and FRC. Any meetings or competitions after those dates will incur additional fees. For FLLJR at least $50; For FLL, FTC and FRC at least $100 but it may be more depending on costs of qualifying event and hotel and travel expenses to and from competitions. For example, if teams qualify for World Championships, cost will be at least $1000 per team member. Team members can fundraise to cover those costs.
Financial Assistance MAY be available through a payment plan or through fundraising, 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 (atleast $100 per team member). 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.
Please check that you understand and agree *
Required
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 Identification *
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. *
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