Grand Rapids Junior Robotics

FLL Registration Form

– registration closes August 30 at 10pm

 

FLL LEGO Robotics – 2018 Challenge Theme:

INTO ORBIT

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Teams

Team 164 - Coach Sam Hartemink, Practice Time Thursday 3:15 - 4:45pm and Saturday 9:30 - 11:30am, Location Grand Rapids Christian Elementary School - Evergreen Campus

Team 165 - Coach Sam Oostendorp, Practice Time Wednesday 6:30 - 8:30pm and Saturday 12:00 - 2:00pm, Location Grand Rapids Christian Elementary School - Evergreen Campus

 

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Participant Information

First Name

Last Name

Team Preference

School

Other School Name

Grade

Date of birth (YYYY-MM-DD)

Age

Gender
MF

T-shirt size

Street Address

City

State
Michigan

Zip Code

 

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Parent's/Guardian's name

Phone Number

Alternate Phone Number

Email address

 
 

Parent's/Guardian's name

Phone Number

Alternate Phone Number

Email address

 

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Emergency Contact

In the event of an emergency, please contact (if parents are unavailable):
 

Name

Primary Phone Number

Secondary Phone Number

 

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Contact me about the following opportunities with GR Jr. Robotics:

Additional Information: