Dublin Robotics

Dublin Robotics Student Registration and Parent Registration Form 2012-2013

Student’s Name: ________________________________________________________
Address: ______________________________________________________________
Student’s Home Phone: __________________________________________________
Student’s Cell: _________________________________________________________
Student’s Email Address: ________________________________________________
High School: Coffman Jerome Scioto :  Grade: ________

Registration for Robotics:
$85 registration fee to the Dublin Robotics Boosters: The Boosters is a tax exempt organization that supports all Robotics and LEGO League programming in Dublin. They also organize fundraising efforts and pursue corporate donations. Your money is essential to start activities in the fall and to register with the national FIRST (For Inspiration and Recognition of Science and Technology) organization. Please make your check payable to “Dublin Robotics Boosters” and write both your child’s name and school in the memo line. We encourage all parents to be a member of the Dublin Robotics Boosters and support the organization for the future of the entire program.

Registration Form: Please return the registration form and check to Joyce Edwards, VP High School Robotics, 7736 Richens Drive, Dublin, OH 43017 or to your student’s Robotics advisor: Greg King or Troy Dramble, for FRC and Jim Roscoe for FTC. Additional contact information is available at www.DublinRoboticsBoosters.org and www.DublinRobotics.com.

Refunds:. Fees are non-refundable after the first 2 weeks of participation.
Scholarships: If the cost of this program is a hindrance to registration, scholarships are available. Email Greg King, Robotics advisor, at king_greg@dublinschools.net for confidential details.

Are ;you interested in being on the parents committee? Circle: Yes No
Father’s Name: ____________________________________________________________
Father’s Home Phone: _______________________________________________________
Father’s Cell: _______________________________________________________________
Father’s Address: ___________________________________________________________
Father’s Email Address(es): ___________________________________________________ Mother’s Name: ____________________________________________________________
Mother’s Home Phone: _______________________________________________________
Mother’s Cell: _______________________________________________________________
Mother’s Address: ___________________________________________________________
Mother’s Email Address(es): ___________________________________________________
____________________________________________________________________________
I give permission for my child to register for Dublin Robotics and for the Dublin Robotics Boosters to contact me through the email address and phone numbers listed here. This information is given for the private use of the team, advisors and Boosters only and is not to be otherwise released. I have read the information on this registration form and agree to comply with it.

____________________________________________________________________________
(signature) (date)
Thank you for supporting the team and the Boosters.