YBB Registration WA1: Jun 12 - 16, 2017 / 1pm - 4pm
1. Please complete the registration form below and CLICK THE SUBMIT BUTTON.

2. CLICK the PAY NOW button on the left to make your payment.

Camper 1 First Name *
Your answer
Camper 1 Last Name *
Your answer
Camper 1 Birth Date *
Please use mm/dd/yy format
Your answer
Camper 2 First Name
Your answer
Camper 2 Last Name
Your answer
Camper 2 Birth Date
Please use mm/dd/yy format
Your answer
Camper 3 First Name
Your answer
Camper 3 Last Name
Your answer
Camper 3 Birth Date
Your answer
Parent/Guardian Full Name *
Your answer
Home Phone
Please include area code
Your answer
Cell Phone
Please include area code
Your answer
Email Address *
Email is our primary method of communication
Your answer
Emergency contact name *
If different from Parent/Guardian above. Please enter full name.
Your answer
Emergency contact phone number *
If different from Parent/Guardian above. Please include area code.
Your answer
Authorized Guardian
Aside from the Parent/Guardian above, only the additional adults below are authorized to pick up the camper: Please include full name, relationship to the camper, and phone.
Your answer
Allergies to foods or environment
If the camper has any allergies, please state below.
Your answer
Other comments
If your child has any special needs, please explain. This will help us in pairing campers for teams. Due to the interactive teamwork nature of these camps, the ability to work well with others is critical. There is a high degree of partner interaction through the intensive 5-day camp. If your child cannot work well with others, then this camp may not be appropriate.
Your answer
How did you hear about YoungBotBuilders?
Your answer
Desired team member
Is there another camper who is also attending this camp that you would like to be paired up for the week? If so, please enter that camper's name below. We work in teams of 2 all week.
Your answer
Liability Release *
I understand that neither YoungBotBuilders, LLC nor its owner nor anyone connected with the camp will be liable for accidents, medical, dental or other expenses incurred as a result of accidents sustained during or as a result of any activity/instruction given to the applicant by the camp staff. I hereby authorize the staff to act on my behalf according to their best judgment in any emergency requiring medical attention. I agree to indemnity and hold YoungBotBuilders, LLC harmless from any loss or expense including reasonable attorney’s fees for any breach of mine hereunder.
Required
Publicity Release *
I understand that the photography/videos will be used by YoungBotBuilders, LLC for the purpose of publicizing and promoting its programs to the public. I agree to assign my child’s likeness to YoungBotBuilders, LLC for use in such promotions. I agree that photographs/videos are the property of YoungBotBuilders, LLC and consent to their publication.
Required
Cancellation Policy *
We understand that things may come up and you may not be able to attend the camp after registration so the following is our Cancellation & Refund Policy: If you cancel 2 weeks prior to the start of the camp session, you will receive a full refund; If you cancel within 2 weeks of the start of the camp session, you will receive a full refund if there is someone on the waiting list to take your spot, otherwise you will receive a 50% refund; No refunds after the first day of camp. Camp fees cannot be refunded or prorated for days not attended due to illness or other causes. All refunds will be made by method of original payment minus any credit card processing fees. All cancellations must be in writing with an email sent to: elee@youngbotbuilders.com. Cancellation is not complete until you receive a confirmation email.
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