REGISTRATION FORM

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Reg. No. RPR/2017/C_____ S_____ N_____ Date: _____________

My child will be attending Robotics Camp:

o April 17, 2017
o April 24, 2017
o May 08, 2017 Photograph
o May 22, 2017
Childs Name:

Age: _____ DOB: ______________ School: __________________________

Class: ____________________________

Mother Name:
Mother’s Phone: __________________

Father Name:
Father’s Phone: __________________
Mailing Address:

Email Address:
Has your child ever attended a robotics program before?
Medical conditions/allergies?

P.T.O

Received INR 2100 from Mr. /Mrs. /Ms. ___________________________________________

towards the registration of Robotics Summer Camp.
Thank you…