Online Registration - step 1

Please fill out the information below, and click "Go to step 2" at the bottom:
Student Name: 
Age: 
Grade (fall current year): 
Name of School Child Attends: 
Class Code(s): 
Session(s): 
After Care: 
How did you hear about us: 
Parent Name: 
Home Address: 
City: 
State: 
Zip: 
Home Phone: 
Cell Phone: 
Work Number: 
Email: 
Emergency Contact Name: 
Emergency Contact Phone: 


Emergency Release Statement
    
In the event of an emergency,  we will attempt to contact you or your emergency contact number listed above. In the event that someone may not be reached, your child will be taken to the most appropriate emergency facility and will be accompanied by our staff, but will not be held financially responsibility for transportation or medical services. I hereby release the staff and instructors from all responsibility in the event of an accident.  I also allow American Robotics Academy ® to use photographs of the students for use on the website and any other promotional materials.

I agree: