2016-17 Robotics Membership Application
Contact Information
Student's Name
Your answer
Student's Date of Birth
Your answer
Student's School
Your answer
Student's 2016-17 Grade Level
Student's e-mail (a gmail address will facilitate use of the team's electronic resources)
Your answer
Student's Mobile Phone Number (or "none" if none)
Your answer
Parent/Guardian 1 Name
Your answer
Parent/Guardian 1 e-mail
Your answer
Parent/Guardian 1 Mobile Phone Number
Your answer
Parent/Guardian 1 Home Phone Number
Your answer
Parent/Guardian 1 Street Address
Your answer
Parent/Guardian 1 City, State, Zip Code
Your answer
Parent/Guardian 1 Workplace
Your answer
Parent/Guardian 2 Name
Your answer
Parent/Guardian 2 Street Address (or "same" if the same as Parent/Guardian 1)
Your answer
Parent/Guardian 2 email
Your answer
Parent/Guardian 2 City, State, Zip Code (or "same" if the same as Parent/Guardian 1)
Your answer
Parent/Guardian 2 Home Phone
Your answer
Parent/Guardian 2 Mobile Phone Number
Your answer
Parent/Guardian 2 Workplace
Your answer
Allergies or Special Dietary Needs ("none" if none)
Your answer
Skills and Interests
Student's Interests (indicate all that apply)
Required
Student's Previous Experience with Robotics or Making Things
Your answer
Skills and Traits Student Can Offer the Team
Your answer
Permissions
Do you give the team permission to share your contact information and allergy and diet information in a directory for Bit Buckets members and their families?
Do you give the team permission to use your photographic and video image (e.g., on the team's webite, in thank you letters to donors)?
Membership Fees
Membership fees cover the student’s portion of initial expenses. The team conducts fundraising activities to pay other costs, but families may be asked to pay students' expenses for things like travel, lodging, food and team attire. Checks should be made payable to Jackalope Science, Inc.
Which projects are you applying for?
Required
In special cases scholarships may be available to defray the costs of membership. Are you interested in a scholarship?
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