Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.How did you hear about Bytes & Bots?Recommended by friend or colleagueSearch Engine (Google, Yahoo, etc.)Social MediaOther:OtherStudent Information # of Students Registering Selected Value: 1 Student 1 BasicStudent's Name *FirstLastDate of BirthStudent 1 ContGenderMaleFemaleGradeTKK1st2nd3rd4th5th6th7th8th9th10th11th12thSchool AttendingStudent 2 Basic#2 Student's Name *FirstLast#2 Date of BirthStudent 2 Cont#2 GenderMaleFemale#2 GradeTKK1st2nd3rd4th5th6th7th8th9th10th11th12th#2 School AttendingStudent 3 Basic#3 Student's Name *FirstLast#3 Date of BirthStudent 3 Cont #3 GenderMaleFemale#3 GradeTKK1st2nd3rd4th5th6th7th8th9th10th11th12th#3 School AttendingStudent 4 Basic #4 Student's Name *FirstLast#4 Date of BirthStudent 4 Cont #4 GenderMaleFemale#4 GradeTKK1st2nd3rd4th5th6th7th8th9th10th11th12th#4 School AttendingStudent 5 Basic #5 Student's Name *FirstLast#5 Date of BirthStudent 5 Cont #5 GenderMaleFemale#5 GradeTKK1st2nd3rd4th5th6th7th8th9th10th11th12th#5 School AttendingParent InformationParent/Guardian *FirstLastAddress *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Subscribe to our NewsletterYes, sign me up!Would you like to sign up for our newsletter?Emergency ContactLayoutEmergency Contact NameFirstLastRelationshipPhoneOtherHealth Concerns *NoneHealth Concerns areHealth Concern ExplanationSpecial Needs *NoneSpecial Needs areSpecial Needs ExplainedLiability and Hold Harmless Agreement & Talent Release *I have read and agree to the terms listed belowIn the event of an accident, illness, or injury, and the person listed above cannot be reached; I hereby give the program personnel permission to take action as deemed necessary in the best interest of my child. Furthermore, I do not hold Bytes & Bots, its sponsoring agencies, and/or its staff or representatives responsible for injuries to my child, which could occur due to the nature of the activity in which my child is engaged. I also understand that the Bytes & Bots staff reserves the right to terminate the participation of any student when it is deemed in the best interest of either the student or the summer camp programs. I hereby consent to the use of any off and/or on camera performance and/or likeness of my child, with or without name, to be used by Bytes & Bots for educational, research, advertising and marketing purposes without compensation for said use.Signature *Clear SignatureDateSubmit
