203: Advanced VEX Robotics Fall Registration

Participant Name

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School Attending

Age

Grade

Please note that we are collecting information for the next three questions to meet the requirements for grant funding received through the State of Maryland.

Home Zip Code

Number of Individuals in Household

Household Income (2 people)

Household Income (3 people)

Household Income (4 people)

Household Income (5 people)

Household Income (6 people)

Household Income (7 people)

Household Income (8+ people)

Does the student have any medical needs/special considerations?

Allergies (food, environmental):

Medical Conditions or Special Considerations:

Parent or Guardian Name

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Parent or Guardian Phone Number

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Parent/Guardian Relationship

Is there an additional emergency contact different from parent or guardian listed above?

Emergency Contact Name

First NameLast Name

Emergency Contact Email

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Emergency Contact Phone Number

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Emergency Contact Relationship

Class:

Advanced VEX Robotics, Saturdays 10:30AM-12:00PM starting 10/10/26

$175.00

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203: Advanced VEX Robotics Fall Registration

Class:*

Class: