REGISTRATION FORM FOR LEGO ROBOTICS CLASS - July 22-23 9 am – 4 pm    [PRINT]

 

*   Required Fields
* Child's Name:   
* Age:   yrs
* Gender:   
* Parent's Name :   
* Email Address:   
* Phone:   
Alternate Phone:   
* Home Address:   
* City:    * State:    * Zip: 
   
Since lunch and snacks will be provided, does your child have any allergies?

Please list if, Yes.
   

I understand the program fees are Non-Refundable regardless of attendance. ALL FEES DUE BEFORE July 12.

 

In the event I cannot be reached in an emergency, I hereby give permission to physician, selected by the adult leader in charge, to hospitalize, secure proper anesthesia, or to order injection for my child.

 

I will not hold MCA OR AABEA or any representative, including but not limited to, adult members, etc. liable for my son/daughter’s actions.

 

 
* Parent Signature :  Date:     
  [Full Name as Signature]
   
CHILDREN MUST BE PICKED UP BY 4 PM. THERE IS NO AFTER CLASS CARE AVAILABLE.
 

OR

Send in Check to the following address for Registration

 

AABEA

2382 Night Shade Ln,

Fremont CA-94539