Student Robotics & Coding Consent Form

STUDENT ROBOTICS & CODING CONSENT FORM

Student Name:   Date of Birth:   Student ID:

Grade/Program:   School/Organization:

Parent / Guardian Information (If student is a minor)

Program Details

Program Name:   Session Dates:

Lead Instructor:   Contact Phone:

Emergency & Medical Information

Health Insurance Provider:   Policy / ID Number:

Consents, Releases and Acknowledgments

I authorize the named student to participate in the Student Robotics & Coding program and acknowledge that robotics and hands-on coding activities involve tools, batteries, electrical components, moving parts, soldering irons (when supervised), and other equipment that present potential hazards. I have voluntarily selected participation with knowledge of the risks and agree to the consents and releases below by checking the corresponding boxes.

  Participation Consent: I consent to my child's participation in all supervised program activities and related events.

  Photo / Video Release: I grant permission for the use of student images, photographs, video, and project media for educational, promotional, or archival purposes. I understand no compensation will be provided for such use.

  Project & Code Sharing: I permit my child's code and project work to be published to class repositories, showcases, or competition entries under appropriate attribution, subject to program guidelines.

  Technology Use: I authorize my child's use of program-authorized online collaboration tools, coding platforms, and cloud services for the duration of the program. I understand personal information collected will be limited to that necessary for program administration.

  Transportation Consent: I authorize my child to be transported by program staff or authorized volunteers to off-site activities if required, and understand that such transport will be conducted with reasonable safety measures.

  Emergency Medical Treatment: In the event of an emergency, I authorize program staff to secure necessary medical treatment for my child if I cannot be reached immediately. I understand I will be responsible for costs not covered by insurance.

Release and Indemnification: By signing below I, as the parent or legal guardian, release and agree to hold harmless the School, program organizers, instructors, volunteers, and affiliated entities from liability for injury, loss, or damage arising from ordinary risks of participation, except where caused by gross negligence or intentional misconduct. I agree to indemnify these parties against claims arising from my child's actions. This release is intended to be as broad and inclusive as permitted by law.

Code of Conduct & Safety Rules Acknowledgment

I acknowledge that I and my child have read, understand, and will comply with the program Code of Conduct and Safety Rules, which include but are not limited to: following instructor directions, using tools and equipment only as instructed, wearing required personal protective equipment, refraining from disruptive behavior, and reporting safety concerns immediately. Failure to comply may result in removal from program activities without refund.

By signing below I certify under penalty of perjury that the information provided on this form is true and complete to the best of my knowledge and that I am authorized to provide this consent.

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