BTI Builders – LEGO Robotics Workshops Registration All Fields on this form are Required Step 1 of 3 33% Desired Week(Required) Week 1: June 26 – Jun 29, 2023 Week 2: July 10 – July 13, 2023 Week 5: July 31 – August 3, 2023 Week 6: August 7 – August 10, 2023 Week 7: August 14 – August 17, 2023 Week 8: August 21 – August 24, 2023 You selected Week 1: June 26 – Jun 29, 2023You selected Week 2: July 10 – July 13, 2023You selected Week 3: July 17 – July 20, 2023You selected Week 4: July 24 – July 27, 2023You selected Week 5: July 31 – August 3, 2023You selected Week 6: August 7 – August 10, 2023You selected Week 8: August 21 – August 24, 2023You selected Week 7: August 14 – August 17, 2023YES! Please register my child for this BTI Builders Lego® Robotics Workshop $600.00 Workshop Fee (Checks Only) Parents registering more than 1 child (sibling) will receive $100 discount off each additional registration.I am applying for a STEM equity scholarship for my child to attend BTI Builders Lego® Robotics Workshop Scholarship Applicant Type of Scholarship(Required) I am applying for a full STEM equity scholarship for my child to attend BTI Builders Lego® Robotics Workshop I am applying for a partial STEM equity scholarship for my child to attend BTI Builders Lego® Robotics Workshop Partial scholarship applicants are encouraged to cover one half ($300) of the Workshop Fee.Please use the space below to to describe your need for financial assistance (optional) Parent Name(Required) First MI Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) Email Participant Info(Required) First Last Date(Required) MM slash DD slash YYYY Gender(Required)GenderMaleFemaleNon BinaryT-Shirt Size(Required)Youth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XLAllergies(Required) EMERGENCY CONTACT INFOEmergency Contact 1 Name(Required) Email(Required) Mobile Phone(Required)Emergency Contact 1 Relationship to child(Required)Relationship to childParentLegal GuardianFamily FriendFamily MemberOtherPlease specify relationship for Emergency Contact 1(Required) Text Messages OK to receive text messages Emergency Contact 2 Name(Required) Email(Required) Mobile Phone(Required)Emergency Contact 2 Relationship to child(Required)Relationship to childParentLegal GuardianFamily FriendFamily MemberOtherPlease specify relationship for Emergency Contact 2(Required) Text Messages OK to receive text messages CONSENT FORMS(Required) I agree to the BTI Builders – LEGO Robotics Workshop Policies* BTI Builders – LEGO Robotics Workshop Medical Emergency Protocol(Required) I agree to the BTI Builders – LEGO Robotics Workshop Medical Emergency Protocol* May we include your child in photos and/or videos?(Required)YesNoPhotos/videos taken may be used for future promotional material.Will you need early drop off (starting at 8:00 am) or late pick up (available until 4:30 pm)? If you answer yes, our Workshop Coordinator will reach out to you to make arrangements. Yes Early Drop Off Yes Late Pick Up I Need Both How did you hear about us?(Required) BTI Builders Summer Workshop Questions 857-303-6635BTIBuilders@bostontechinitiative.org
