Robotics Class Sign-Up Form

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Fill out all information that applies to you.

Student's Name *

(First Last)

Grade *

(4-8 Choose 1)

Grade

Parent/ Guardian Name *

(First Last)

Parent/ Guardian Phone Number *

(510)-555-5555

Email *

Address *

43531 Mission Blvd., Fremont, CA 94539

Emergency Contact

(First Last)

Relationship to Student *

(Family friend, Dad, Mom, Uncle...etc.)

Emergency Contact Number *

(510)-555-5555

Make checks payable to Olive Children Foundation *

Payment $160, Drop off Checks at Olive Children Foundation or call 5105083292 for alternate drop-off locations

Okay

Submit

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