Team Member Registration Form
This is an application from but payments must be made at time of submission. If we do not have enough space for your child to participate then all fees will be returned.

Membership Fee for the 2019/2020 Season for FRC members is $400 and for FLL members $250.

FRC Members working in the machine shops must provide their own CSA Approved safety footwear.

It is expected that FRC Members will attend at least 65% of scheduled Team Meetings and at least
two outreach activities each season.

FLL registration is closed.
I am interested in joining: *
Student Contact Information:
First Name *
Your answer
Last Name *
Your answer
Home Address *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Email *
Your answer
Grade (as of September) *
Your answer
School *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Languages Spoken *
Your answer
Emergency Contact Information:
Primary Contact's Name *
Your answer
Relation to Student *
Your answer
Primary Contact's Home Phone *
Your answer
Primary Contact's Cell Phone *
Your answer
Primary Contact's Email *
Your answer
Secondary Contact's Name *
Your answer
Relation to Student *
Your answer
Secondary Contact's Home Phone *
Your answer
Secondary Contact's Cell Phone *
Your answer
Secondary Contact's Email *
Your answer
Primary Contact's Home Address (if different from student)
Your answer
Please describe how you can support the team. *
Your answer
Payment must be made to complete registration. If you have any questions please email niagararobotics@gmail.com.
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