Wangaratta Robotics Club Registration Form
Term 3 2020
Email address *
Child's Name *
Child's Date of Birth *
Child's current age and grade at school *
Child's School *
Parent/Guardian Name *
Street Address *
Town *
Postcode *
Email *
Phone number *
Emergency Contact Name *
Emergency Contact Phone *
Emergency Contact relationship to child *
Does your child have any medical conditions that may require an emergency response *
If yes above, please provide some details
If yes, I accept that I am responsible for providing a copy of a current emergency management plan relevant to my child's specified health condition
Clear selection
I consent to the adults responsible for supervising the activities my child will participate in at the Wangaratta Digital Hub, seeking any emergency medical assistance (including ambulance) deemed necessary for my child whilst at the Wangaratta Digital Hub *
I understand that my child may be using tools and equipment to build their robots which can present a minor safety risk. *
Has your child done any robotics before? *
If yes above, where did they do robotics?
How would you describe your child's current level of robotics ability? *
Please tell us how you heard about the Wangaratta Robotics Club? *
Do you consent to your child being included in photos and videos at the Robotics Club and to these images being used for promotional purposes which may include media publications, social media, websites, educational displays and hub presentations etc. *
I understand that my child needs to be signed in and out of each Robotics session by the adult responsible for dropping off or picking up my child *
If I am unable to personally pick up my child at the end of a Robotics Session, I consent to: *
Under the above arrangement I understand and accept that Wangaratta Digital Hub has no responsibility for my child once my child is signed out at the end of a session and I assume full responsibility for all risks associated with my child traveling home independently or with a nominated person.
Clear selection
Name, phone number and relationship to child of person/s nominated as authorised by me to pick up my child from the Wangaratta Digital Hub if I am unavailable to do so. **Please note that your child will not be released to anyone not listed below
The Wangaratta Robotics Club has been established by volunteers with the support of the Wangaratta Digital Hub. We ask that parents/guardians volunteer to assist for at least one or more sessions during the term ( no experience required) Please indicate which session/s you can volunteer to assist with? *
Does your child have access to: *
Please provide any other information (if applicable) about your child that you would like us to know to assist in meeting your child's individual learning needs?
Safety and Liability Statement *
By submitting this form I declare that I have read, understood and accept the Robotics Club Participation Agreement downloadable on the Wangaratta Digital Hub website. *
By submitting this form I declare that I understand that the Wangaratta Digital Hub staff and volunteers will rely on the information provided on this registration form and I confirm that the information is true and correct. *
Date that I read and understood the above statements *
Thanks for completing this form. You will soon receive an email with details about how to pay your membership and purchase your preferred robot kit if your child is one of the first 15 to register. If you are a returning student and only wish to buy a few extra parts, please contact the Digital Hub.
A copy of your responses will be emailed to the address you provided.
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