2010 Summer Robotics+Chess Workshops Registration Form

At Dean of Chess
Personal Contact Section
Date:
 
Avoid Spam! < Enter the capital city of New Jersey.
 Participant's Name:    D.O.B.:   Gr. Level:  M   F
   

(by the Fall of 2010)
Parent/Guardian:
Home Address:
City:   State    Zip:
       
Home  Phone (xxx-xxx-xxxx)

Work:

Cell:

E-Mail Address:

You will receive registration and payment confirmation thru email.
Extended Care:   Important notes:
  • Only available if you register for a full day or afternoon session.
  • Flexible but must be informed no later than the first day of your workshop(s).
  • Must submit credit card authorization for this charge.
  • No charge is made until the end of workshops.
  • $15/hr with 10 minutes into an hour will be considered to be as full hour.  

do not need  until 4pm    until 5pm    until 6pm
Previous Robotics Experience No LEGO Mindstorms Experience
Some LEGO Mindstorms Experience
FIRST LEGO League Experience
Have other robotics programming: 
Learn about us:             Others:
Emergency and Physician Contacts
Contact Ph:  
Physician Ph:  

Allergies/ medication/ or other conditions that we should know
 
Misc. Information
Lunch Purchase   I am not   I am interested.
Note:(You only pay if you choose to order.  Selection and payment must be made at the drop-off time)

Workshops Selection Section
Location: Dean of Chess
Get Direction
Chess Track Engineering - Simple Circuitry & PreRobotics Discount
Jul 12-16 am Jul 12-16 pm  -$40 if sign up for both AM and PM within the same week 
Jul 19-23 am   Jul 19-23 pm
Jul 26-30 am   Jul 26-30 pm
Aug 2-6 am   Aug 2-6 pm
Aug 9-13 am   Aug 9-13 pm
Aug 16-20 am   Aug 16-20 pm
* Take home participation medal *
* Best performer receive additional trophy *
Tuition adjustment Section

 Subtotal
Morning and Afternoon Discount - $
 I am the sibling of another student named - $
Note: ONLY apply to the camper with the lower or equal value. Max -$100.
  
   Register Now (-$30 by 2/15, -$20 by 3/15, -$10 by 4/15 - $
  I have read and agreed to the Refund Policy ***
 My child Has Read  and agreed  to conform with the  code of conduct  at the Center. ***
(Please note that *** Must be checked in order to be accepted into our programs.)

Total Camp Fee Due:

$

Submit Now:

$
Dear parents, it is important that your child has read our code of conduct and he/she will have no problem to conform.  The quality of these robotics workshops/robocamp programs relies not only on the high quality of our staff and programs, but also the cooperation and respect from the students.

Note: We shall regret not to accept student who does not agree to our code.

Important Note:

  • Staff is not permitted to dispense medications.  Arrangements MUST be made accordingly before the beginning of your registered session.  
  • Your online submission will reserve a seat.  Please note that a camper is not fully registered until we have received the "Total" camp fee.   An enrollment confirmation will be sent to you as soon as payment is received. 
  • Checks returned for insufficient funds will be charged $50, which includes $15 processing fee and $35 bank fee .
  • The center is not responsible for lost and/or left-behind personal property. You must come in to pick up left-behind items.
Comments or Questions or email us at robocamp @ storminigrobots.com
maximum 2000 characters)
payment Section
Select Payment Option:
Full payment
$250 down payment to reserve a seat
*** must check one of the following if this option is selected:
 Charge remaining balance on June 1st, 2010. (Must provide CC authorization below.)
  Pay balance with check by June 1st, 2010.
      (Please submit on time in order to avoid $10 Late Charge which will incur
       after June 1st,  10).
 
Select Payment Method:
Submit Payment with Check. (Must meet the minimum deposit.)
Submit CC Payment.
    (This selection will bring you to the payment page. Please make sure your browser will allow pop up.) 		 
 

If you choose to pay with check, please make checks or money orders payable to: Storming Robots. Mail it to:
Storming Robots
3322 Rt. 22 West, Suite 402
Branchburg, NJ 08876
  
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