Science Olympiad, Robotics 2019/20

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form constitutes permission to attend the event, the code of conduct agreement and medical authorization in the case of an emergency. Only one form needs to be completed for the 2019/20 school year.

Email *

What team(s) are you on? (Select all that apply)

Science Olympiad

Robotics

Student Last Name *

Student First Name *

Parent's Name(s) *

Home Phone *

Parent's Cell Phone *

Student's Cell Phone *

Student's Email *

My Child is permitted to use the following modes of transportation *

Students must indicate when signing up for an event, if they will need bus transportation from Benet

Benet Bus: Provided for Harlem, CLC, Joliet, COD, ALL Robotics Events

Drive themselves: available only with written parent permission

Required

Current Prescription Medications & Dosage *

Type None if not applicable

Current Non-Prescription Medications & Dosage

Type None if not applicable

Known allergies (medications, food, etc) *

Type None if not applicable

Please add any additional notes regarding special conditions requiring monitoring such as diet, special medical issues, etc. *

Type None if not applicable

Events student is permitted to attend: *

2019/20 Science Alliance Competitions (It is assumed you child is available for all events but please check your calendars for any conflicts ahead of time)

Harlem Invite (12-14-19)

Crystal Lake Central Invite (1-25-20)

Joliet West Invite (2-15-20)

College of Dupage Regional Qualifier (3-4-20)

ROBOTICS - Neuqua Valley (Freshman Campus) (1-18-20) (22000C only)

ROBOTICS - NEIU Invite (2-1-20)

ROBOTICS - Great Lakes #3 @ Batavia HS (Sunday 2-9-20)

ROBOTICS - OPT4STEM VRC @ Illinois Tech (2-22-20)

ROBOTICS - Great Lakes #4 @ Batavia HS (Sunday 3-1-20)

Required

Date of Permission *

YYYY

Signature (typing the parent name constitutes the parent signature) *

In the case in which medical treatment is required, I give permission to obtain the services of a licensed physician and ask to be notified immediately. In consideration for making the arrangement of this event, I hereby release and save harmless Benet Academy and its employees from any and all liability as a result of any injuries sustained to the above named student during this event. furthermore, I understand that all rules and policies in the Benet Academy Student Handbook are applicable at this event, and that infractions by the above named student will be dealt with according to Benet Academy disciplinary procedures.

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Benet Academy. Report Abuse

Forms