CLC Program Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

After-school Program Registration

Program *

FLL Robotics Club

Participant's Name *

Participant's Age (9+) *

School *

Phone Number *

Email *

I HERE GRANT MY CHILD OR CHILDREN PERMISSION TO ATTEND CLC CLASSES, FIELD TRIPS, AND OTHER OFF-SITE ACTIVITIES. *

Yes

Photography Consent

I give the Challenger Learning Center of Lockport permission to use my child's name, likeness, image, voice, and/or appearance as such may be embodied in any pictures, photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf of CLC of Lockport activities. I agree that CLC of Lockport has complete ownership of such pictures, etc., including the entire copyright, and may use them for any purpose consistent with the CLC of Lockport mission. These uses include, but are not limited to illustrations, bulletins, exhibitions, videotapes, reprints, reproductions, publications, advertisements, and any promotional or educational materials in any medium now known or later developed, including the Internet.
*

Yes, I give permission

No, I withhold permission

Communications Options *

Please add me to your mailing list to receive updates.

I am already on the list. Thank you!

Please do not add me to your mailing list.

Required

How did you hear about us? (Choose all that apply) *

Friend/family

Facebook

Instagram

News

Newspaper

Other

Required

If other please specify

Comments

Any other considerations we may need to know about?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms