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Bruin Bots Middle School Robotics Club 2014 Registration Forms

Bruin Bots Middle School Robotics Club 2014 Registration Forms

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Registration forms for the Bruin Bots Middle School Robotics Club, a free after-school program offered from 4 to 5:30 p.m. Tuesdays and Thursdays Feb. 6 through May 15 at Kellogg Community College's Regional Manufacturing Technology Center in Battle Creek, Michigan.
Registration forms for the Bruin Bots Middle School Robotics Club, a free after-school program offered from 4 to 5:30 p.m. Tuesdays and Thursdays Feb. 6 through May 15 at Kellogg Community College's Regional Manufacturing Technology Center in Battle Creek, Michigan.

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Published by: Kellogg Community College on Jan 23, 2014
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01/31/2014

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1.

Contact Informaton:
STUDENT NAME ___________________________________________________________________
DATE OF BIRTH _____________ GRADE ______ SCHOOL __________________________________
ADDRESS _________________________________________________________________________
CITY/STATE/ZIP ____________________________________________________________________
PARENT / GUARDIAN EMAIL __________________________________________________________
EMERGENCY CONTACT 1 ____________________________________________________________
PHONE 1 ________________________ PHONE 2 ____________________________
EMERGENCY CONTACT 2 ____________________________________________________________
PHONE 1 _________________________ PHONE 2 ____________________________


2. Meetng Schedule: Bruin Bots club meetngs will occur at the RMTC at the following tmes:
 Tuesday and Thursday from 4:00pm to 5:30pm
 Thursday, February 6th , 2014 through Thursday, May 15th, 2014
Club members should try to be present at all meetngs. If for some reason a team
member must be absent it would be helpful to note those dates now for planning purposes. Please
indicate any days you know your student will be absent below:
___________________________________________________________________________
If for some reason a team member must be unexpectedly absent from practce, please contact
Kimberlee Andrews-Bingham at 269-565-2802 or andrewsk@kellogg.edu and leave a message.


Kellogg Community College Bruin Bots
Middle School Robotics Club - REGISTRATION FORM
Please complete and return to:
Regional Manufacturing Technology Center, 405 Hill Brady Rd, Batle Creek, MI 49037
or Fax to: 269.962.7370
Registraton will not be complete untl this form is returned.
4. Release and Waiver of Liability - Please read carefully before signing.
The undersigning hereby acknowledges that partcipaton in this program and
related actvites involves an inherent risk of physical injury, and the undersigned,
on behalf of the registrant, hereby assumes all such risk and does hereby release
and forever discharge the program and the college, and all employees and agents
thereof from any and all liability of whatever kind of nature, arising from and by
reason of any and all known and unknown injuries, damage to property, and the
consequences thereof, resultng from the registrant’s partcipaton in or involve-
ment with this program, including failure of equipment or defect in premises.

Child’s Name _________________________________________________________
I hereby state that I am the legal guardian of said child and agree to the above
statement:
_________________________________________________ _______________
Printed Name Date
_________________________________________________
Signature
5. Photo Release: I authorize KCC to use images, videos and audio of my child (or minor for
which I am legally responsible) captured during college sponsored actvites for use in promo-
ton, publicatons and materials. I understand that all images, videos and audio will solely be
used for college purposes and that I will not be compensated for my image, voice or comments.
I also understand that KCC owns all images and recordings.
Minor child’s name: ______________________________________________________
Parent / Legal Guardian: ______________________________________________________

________________________________________________
Signature


Please note students
should not bring any
Lego or building
materials to practce.

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