ITWomen Summer Robotics Camp ITWomen 2018 Summer Camp Registration Thank you for interest in this year's ITWomen Robotics Summer Camp. We will run two sessions during the month of June at Northeast High School, 700 NE 56th Street, Oakland Park, FL 33334. Name* First Last Grade in 2018-2019 School YearPlease select the student's grade level for the upcoming school year (beginning August 2018)12th11th10th9th8th7th6thSummer Camp SessionPlease select one session from the following choices: June 11-14, 9am-4pm June 18-21, 9am-4pm I am flexible. Please let me know which session has availability. T-shirt size*XLLMSEmergency Contact #1*In case of emergency, please provide the phone number of a Parent/Guardian that may be reached immediately. First Last Emergency Contact #1 Phone*Emergency Contact #2 First Last Emergency Contact #2 PhoneHealth Conditions/AllergiesPlease describe any health conditions or allergies of which we need to be aware. If none, kindly state "None" in the field.Health/Accident Insurance*Yes, I hereby affirm that my child is covered by 24-hour student accident or family insurance.No, I do not have insurance, but hereby affirm financial responsibility for any/all medical bills for emergency care for my child.Health/Accident InsuranceIf you answered "Yes" to the insurance question above, please provide the name of your insurance company/provider and the policy numberMedia ReleaseI hereby grant permission for ITWomen to utilize photographs of student in promotional materials pertaining to the Summer Robotics Camps on ITWomen's website, social media accounts and press efforts which acknowledge generosity of the camp sponsors.YesNoName of Parent/Guardian Completing This Form*I certify that I am authorized to complete this form on behalf of this student. First Last Parent/Guardian Email*We will use this address to confirm your camp registration, provide updates or communications regarding the camp. Enter Email Confirm Email Signature of Parent/Guardian*Kindly retype your full name here as your Electronic Signature of this form.