LSW Robotics Summer Program 2019
Student Last Name *
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Student First Name *
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Camp Selection *
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Parent Name *
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Parent E-mail Address *
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Additional e-mail address (optional)
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Parent/Emergency Phone Number *
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Additional Emergency Phone Number (optional)
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By submitting this registration I give camp staff authorization to act on my behalf in the event of a medical emergency. *
Please list any allergies or other medical conditions the camp staff should be aware of:
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Student's current school (2018-2019) *
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Student's current grade (2018-2019)
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T-Shirt Size *
Registration must be received by May 6 to insure T-shirt availability
Payment Method:
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