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CS+X Robotics Afterschool
By registering for this program you agree to allow photos and videos of your child at the program may be published in any promotional media and devices at the sole discretion of CS+X.
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Email
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Your email
Name of Child
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Date of Birth
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Your answer
Parent or Guardian Name
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Contact Phone Number
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Contact Mailing Address
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Emergency Contact Name
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In the event the above parent/guardian cannot be reached at the provided contact number, please provide a second contact that we may call.
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Emergency Contact Number
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Any known allergies
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if none please type "none"
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Do you have any concerns you would like us to know about in advance?
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I agree to allow the CS+X Foundation to obtain medical care for my child in the event of injury.
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How did you hear about our program
Orpheum Website
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This program is free to those who live in a R3 zone or qualify for free or reduced lunch
Please type you address into the search bar on this web page to check if you are in an R3 zone:
https://r3.illinois.gov/eligibility
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You're location will be highlighted if you live inside one.
Does your child live in a R3 zone?
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Does your child normally qualify for free or reduced lunch through school?
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