FTC Registration The following form is to be completed to register for the 2021-2022 First Tech Challenge. The fee must be received before registration is considered complete. Student Information New Registration? Yes No - I participated previously First Name * Last Name * Gender Male Female Address * City * State * Ohio ZIP * Home Phone * Cell Phone Email Address Grade (2021-2022 School Year) * 7 8 9 10 11 12 NOT the grade they are in today, but the grade they will be in the 2021-2022 school year. Students must be between the ages of 9 and 14 by January 1st of the 2021-2022 school year in order to participate School Coffman Jerome Scioto Sells Karrer Davis Grizzell T-Shirt Size * Youth: Medium Youth: Large Adult: Small Adult: Medium Adult: Large Adult: XL Adult: XXL Preferred Contact * Primary Only Both Parent Information Primary Contact Parents Committee? Yes No Please choose if you would like to be on the parents' committee. Relationship Father/Guardian Mother/Guardian What is the primary contact's relationship to the student? First Name * Last Name * Email * Home Phone Cell Phone Special Interest/Notes Secondary Contact Relationship Father/Guardian Mother/Guardian First Name Last Name Email Home Phone Cell Phone Payment When you submit this form, you will be sent to PayPal to make your payment. If you have already paid by check, made out to "Dublin Robotics Boosters", please do not also pay via PayPal. If you are unable to pay this fee, you may apply for a grant by choosing "Grant" for the payment method. You will also need to complete a Fee Waiver Form which we will email to you. All students of the Dublin School System are elligible and encouraged to participate in the robotics program. Registration fee ($85) and Pizza fund($15) are $100 Fees are non-refundable after the first 2 weeks of participation If the cost of this program is a hindrance to registration, scholarships are available. Email Greg King for confidential details. Payment Method * PayPal Check Apply for Grant Please make checks payable to "Dublin Robotics Boosters" and send payments to (DO NOT MAKE CHECKS OUT TO THE TEAM'S COACH): Dublin Robotics Boosters PO Box 2059 Dublin, OH 43017 Or attend one of the information sessions. Agreement By submitting this form, I give permission for my child to register for Dublin Robotics and for the Dublin Robotics Boosters to contact me through the email address and phone numbers lists above. This information is given for the private use of the team, advisors and Boosters only and is not to be otherwise released. I have read the information on this registration form and agree to comply with it.