Parents Registration and Permission Slip to Participate

Dear Parent or Legal Guardian:

Your son/daughter, is eligible to participate in the STEAM class/Robolab/ FLL team *(needs to meet requirements*), Innovation class, etc. These activities will take place under the guidance and supervision of staff/volunteers from the Filipino Community of Seattle or FCS STEAM Camp programs: A brief description of the activity follows:

Activity Goal: SPIN STEAM Lab Camps at FCS, EAC, Bellevue, and SODO Makerspace

Date and time: Varies

Method of transportation: Parents Transport self/youth at location ( as determined by schedule)

Cost: $0 (Donations welcome)

Participant's Full Name *

Participant's Full Name

First Name

Last Name

Birthdate *

Birthdate

YYYY

Grade *

Gender *

Female

Male

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone *

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

School *

Student ID # *

Email Address *

Class your interested in registering for *

Choose all that apply

Robo Lab Drop Ins

Intro to Basic Circuits and Electronics (For ages 8-14)

Intro to Arduino (For ages 8+)

Filipino Community Center: Robo Lab (For ages 6+)

Intro to Arduino: Using Stop light & Lego (For ages 8+)

Intro to Scratch (Programming) (For ages 8+)

Intro to 3D Modeling (For ages 8+)

Intro to Photoshop (For ages 15+)

Intro to 3D Printing (For ages 18+)

Parent/Guardian Information

Parent/Guardian's Full Name *

Parent/Guardian's Full Name

First Name

Last Name

Relationship with Student *

Address (If different from student)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Phone Number *

Contact Phone Number

(###)

###

####

Email *

How did you hear about the program? Who referred you to this program? *

Does your child receive free/reduced lunch at school? *

Yes

Does your child live in section 8 housing? *

Yes

Does your child live in a temporary shelter? *

Yes

Ethnicity *

Medical Information

Student registered above has the following medical problems that you need to be aware of during the activity *

Please list in detail

Safe drop off and pick up process

Supervision will be provided to safely guide the students upon drop off and pick up during the sessions. It is required that parents of authorized persons physically come into the activity room to sign-in and sign-out their child at each session.

BESIDES PARENTS, PLEASE LIST NAME/S OF AUTHORIZED PERSONS TO PICK UP YOUR CHILD *

BESIDES PARENTS, PLEASE LIST NAME/S OF AUTHORIZED PERSONS TO PICK UP YOUR CHILD

Please note: Authorized persons must be an adults or an older sibling in high school or above. We will only allow your child to leave with the people you list here. A Photo ID or Password will be required.

First Name

Last Name

Relationship *

Authorized Person 2

First Name

Last Name

Relationship

ELECTRONIC SIGNATURE of Parent/Guardian 1 *

ELECTRONIC SIGNATURE of Parent/Guardian 1

First Name

Last Name

ELECTRONIC SIGNATURE of Parent/Guardian 2

First Name

Last Name

Emergency Contact Name *

Emergency Contact Name

First Name

Last Name

Contact Number *

Contact Number

(###)

###

####

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country