FLL Jr. Registration 2019-2020

Applicant / Child Information (Part 1 of 3)

If you are making application for more than one child, you WILL need to fill out the complete application for each child. Thank you.

Child's FIRST Name*

Child's LAST Name*

Child's DOB*

mm/dd/yy

Child's Current Grade Level*

Child/Applicant Tshirt Size*

All sizes are YOUTH

Parent / Guardian Information (Part 2 of 3)

Parent Guardian's FIRST Name*

(This is the adult that will be attending Saturday group meetings with the child.)

Parent Guardian's LAST Name*

Parent/Guardian Phone Number*

Parent/Guardian Email*

Parent/Guardian Home Address*

Parent/Guardian Email*

Would you like to receive updates from Bananas Robotics regarding FLL/FLLJr. by email?*

Yes, add me to the FLL/FLLjr email notifications list
No, don't add me to the email list.

We do not sell or distribute email addresses, and you will ONLY be added to our email newsletter list. We hate SPAM too.

Adult Supervisor/Mentor Acknowledgement*

Group practice sessions will be held over multiple weekends at a centralized Treasure Valley location for the season. An adult mentor will need to attend AND participate with each student (one adult may supervise 2 siblings on the same team), be responsible for that student, and provide transportation. This mentor will also be responsible to coordinating with other team parent/guardians on their child's team to facilitate 1-2 team work days between group sessions for their team.

I have read, understand, and accept this Adult Mentor requirement.

FLL Junior Registration (includes t-shirt and end of season Expo)*

Price: $50.00

Parent T-Shirt

Price: $10.00

Total

This total will not be charged at this time. It is solely for your acknowledgement, and we will send you an invoice to pay by PayPal within one week. You WILL need to complete payment prior to the start of the program or you may be placed on a wait list.

$0.00

If You would like a Parent/Guardian Tshirt, please select your size*

(all sizes are unisex/mens. If you would like multiple adult shirts, please clearly state size and quantity in the "other" fieldl)

Additional Information (Part 3 of 3)

Home Address or Major Cross Streets*

This is solely used to try to form teams within close proximity. 6 children will be placed on a single team, and will need to meet at times outside of the Saturday "Group" meetings on the schedule. If you do not provide your address here, you will need to provide it to staff privately prior to the start of the program for placement.

Please check any statements that apply to your applicant. (optional)

Responding to these questions is optional, but does assist us in securing funding for future projects and reporting to certain funding sources on this project that seek to increase the presence of underrepresented populations in STEM fields.

Applicant is female.
Applicant is a from a minority ethnic group.
Applicant participates in a free or reduced lunch program.
None of the above apply.

What school do you attend?*

If you have multiple children from the same family applying, please enter siblings full name(s) here for cross reference. Thank you!

Email

This field is for validation purposes and should be left unchanged.

Apply for Bananas FLL Jr. 2019-2020

Applicant / Child Information (Part 1 of 3)

Parent / Guardian Information (Part 2 of 3)

Additional Information (Part 3 of 3)

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