FRC Team 4931 Registration 

*T-shirt Size (choose one)                     - Select -                               ADULT SMALL               ADULT MEDIUM ADULT LARGE                                                                                 ADULT X-LARGE ADULT XX-LARGE     ADULT XXX-LARGE Previous Experience in Robotics or FIRST?

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Any additional information you feel Edwardsville Robotics or Team Coaches may need to know about the student? Additional interests?

 

PARENT / GUARDIAN INFORMATIONAny special custody arrangements we should be made aware of? (If so, please provide a copy of the most recent Custody Order)

 

FATHER / LEGAL GUARDIAN*Name of Father / Legal Guardian

*Phone Number

Additional Phone Number (if needed)

*Email (one email is required - please type NA if one is not available for this parent)

*Would you like this email to be included in the mailing list?

Occupation

*Would you be interested in Mentoring or Coaching?

Any special skills or hobbies pertaining to this organization? (Engineering, teaching, fundraising, electronics, tool and die, computer programming, web design, journalism, business, art, graphic design, etc.)

 

MOTHER / LEGAL GUARDIAN*Name of Mother / Legal Guardian

*Phone Number

Additional Phone Number (if needed)

*Email (one email is required - please type NA if one is not available for this parent)

*Would you like this email to be included in the mailing list?

Occupation

*Would you be interested in Mentoring or Coaching?

Any special skills or hobbies pertaining to this organization? (Engineering, teaching, fundraising, electronics, tool and die, computer programming, web design, journalism, business, art, graphic design, etc.)

 

MEDICAL INFORMATION*Doctor's Name and Phone Number

Do you have a hospital preference? **Emergency situations will be taken to the nearest hospital

*Any allergies or medical conditions we should be made aware of?

*Medications (please list) or type NA

 

ADULTS AUTHORIZED TO TRANSPORT STUDENTS (You must designate at least one adult. Please include a phone number.)*Name, Relationship, Phone Number(s)

Name, Relationship, Phone Number(s)

Name, Relationship, Phone Number(s)

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TERMS AND CONDITIONS - available for view under this form

 *By checking this box, I agree to accept the TERMS AND CONDITIONS set forth herein.

*Please enter your name to electronically sign this form. This will serve as your electronic signature.

*Please enter the email address you would like confirmation sent to: