LEGO Robotics Registration Form
This form will register your child for LEGO Robotics classes at Palama! This program is for students aged 7 - 13.

Please fill out one form for each child!

When: Fridays from 3 – 5 p.m. (15 classes)
(Aug 27; Sept 3, 10, 17, 24; Oct 1, 8, 22, 29; Nov 5, 12, 19; Dec 3, 10, 17)
No class on Oct 15 (Fall Break) and Nov 26 (Thanksgiving).
Email *
Participant Information
This section will ask you information about the child you're signing up!
Participant's First Name *
Participant's Last Name *
Participant's Age *
Participant's Gender *
Participant's Grade *
Participant's Birthday *
MM
/
DD
/
YYYY
Home Phone Number *
Address *
Zip Code *
School name *
Does the participant have any medical conditions that we should be aware of? (ie. Asthma, Diabetes, seizures, heart problems, food allergy, drug allergies etc) *
Required
If yes, please provide information, and list any medications being taken.
Physician Name *
Physician Phone Number *
Medical Insurance Carrier *
Policy/Membership Number *
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