2012 PHOENIX HOMESCHOOL ROBOTICS CLUB MEMBERSHIP AGREEMENT STUDENT NAME(S):___________________________________________________________________ PURPOSE Phoenix Homeschool Robotics Club strives

to provide a safe and healthy learning environment for all participants. This release is to inform parents and/or guardians of all activities available, participation guidelines, membership requirements and to establish whether the member is allowed to participate in these activities. Furthermore, by signing this release, you agree to abide by the rules and regulations of the Phoenix Homeschool Robotics Club and to release, indemnify, and hold harmless the Phoenix Homeschool Robotics Club Student and Adult Leadership, FIRST Robotics, and the coaches, teachers, mentors, and parent volunteers of these organizations. SAFETY AND FIRST AID Working with LEGO components in a controlled environment, such as this club, is not dangerous by nature. However, in the event of an emergency, I grant permission for a staff member to provide first aid and/or transportation to my student to an emergency facility. Phoenix Homeschool Robotics Club will also observe any medical notes provided by the students parent. PARTICIPATION Participation in Phoenix Homeschool Robotics Club is a privilege, not a right. In the event of a violation of safety rules, such as horseplay, participants may be dismissed from the meeting or event and subject to club expulsion without refund. PUBLISHING INFORMATION Web Site Phoenix Homeschool Robotics Club has a web site and Facebook group devoted to the club and club activities. Member names, email addresses and other information may be available on this site; however we are careful not to publish any information that is submitted to the club as confidential. Other Mediums Photos and video may be taken of members participating in various club activities. These images and representations may be used on the club website, for brochures and press releases, or for professional videos or news clips for television broadcast. Occasionally, these images are released to 3rd party Page 1 of 3

groups such as news stations or the FIRST Robotics Competition. Phoenix Homeschool Robotics Club is not responsible for the usage of the materials that are released from Phoenix Homeschool Robotics Club ownership. EXPECTATIONS AS A MEMBER: We do have a few expectations of each student in order to emphasize the importance of each members role and to help insure that members feel that they are indeed a part of the FLL program: 1. 2. 3. 4. 5. 6. 7. 8. Must be currently homeschooled. Must be between the ages of 6-14 as of January 1, 2012. Membership Agreement completed and signed (this form.) Registration fee ($30 per family) for the current year paid to the club cashier. Please make checks payable to Eric Richardson. Consistent and dedicated attendance at regularly scheduled meetings. Students who do not maintain regular attendance may be asked to leave the program without refund. Must not willfully damage club equipment. Damaged equipment must be replaced or paid for by the member that caused the damage. Must pay equal respect to all coaches, mentors, parent volunteers, and other club members. If you are disrespectful you may be asked to leave the program without refund. As a club we have adopted the First LEGO League Core Values. Members are expected to work towards and demonstration of these core values at all times. By embracing the Core Values, participants learn that friendly competition and mutual gain are not separate goals, and that helping one another is the foundation of teamwork.

CORE VALUES: 1. 2. 3. 4. 5. 6. 7. We are a team. We do the work to find solutions with guidance from our coaches and mentors. We honor the spirit of friendly competition. What we discover is more important than what we win. We share our experiences with others. We display Gracious Professionalism in everything we do. We have fun.

With Gracious Professionalism, fierce competition and mutual gain are not separate notions. Gracious professionals learn and compete like crazy, but treat one another with respect and kindness in the process. They avoid treating anyone like losers. No chest thumping tough talk, but no sticky-sweet platitudes either. Knowledge, competition, and empathy are comfortably blended.

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FINAL AGREEMENT By signing below, I am acknowledging that I have read and understood all of the information on this member expectation/release form. I am/we are the person(s) legally responsible for the Phoenix Homeschool Robotics Club member named below. I have read this release, and I consent to his or her involvement. I consent to the use of this member's name, image, and/or likeness in online and other publications. As a club member, I will do my best to be safe and encourage a safe work environment for others. I agree to release, indemnify, and hold harmless the Phoenix Homeschool Robotics Club, Phoenix Homeschool Robotics Club Student or Adult Leadership, FIRST Robotics, and the officers, employees, volunteers, and contractors of these organizations from any and all damages related to Phoenix Homeschool Robotics Club activities, to the full extent allowed by applicable law. I understand that this form involves a release of legal rights.

Signature of Student

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Printed Name/Age

Signature of Student

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Printed Name/Age

Signature of Student

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Printed Name/Age

Signature of Parent/Guardian

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Printed Name

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