Student Registration

Student Registration

All funds received are for programs to enable and support high school students in technology, engineering and entrepreneurship. Monumental Impact is a 501(c)(3).
Student

Please fill out one registration separately per student.
Student's Name*

First NameLast Name
Grade*
Entering grade for 2022-2023 school year
School*
Examples: LPMS, BCES, LPHS
Shirt size
While supplies last, students will receive a shirt from Techno Chaos who is a sponsor.
Parent / Guardian
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number
Sessions

Descriptions of sessions are available on our website.
Sessions Available*
prevnext( X )
LEGO Robotics (5 days): Both Tracks Available9AM-3PM. ES Track for Entering Grades 5th to 6th. MS Track for Entering Grades 7th to 8th.
$275 Week



LEGO Robotics (5 days): Middle School Track Only9AM-3PM. Entering Grades 7th to 8th ONLY
$275 Week



Introduction to Web Development w/ Python (2 days)Aug 2nd-3rd (Wed-Thu) 9AM-3PM. Entering 8th Grade or higher
$125



Python for LEGO Robotics (2 days)July 31st - Aug 1st (Mon-Tue) 9AM-3PM. Entering 8th Grade or higher
$140



DIY Drone WorkshopAug 4th (Fri) 9AM-12PM. Entering 7th Grade or higher. Participants take home the drone they build which is valued over $200.
$235



Soldering / Electronics WorkshopAug 4th (Fri) 12:30-3PM. Entering 7th Grade or higher. Participants take home the item they solder and build.
$30



3D Design for 3D Printing & Team Collaboration (4 days)Aug 7th-10th (Mon-Thu) 9AM-3PM. Entering 8th Grade or higher.
$250



Total

$0.00
Payment

Online via our PayPal Giving Fund and make sure to check the option to "Share my name and email with this charity" so we can match your payment to your student's registration:

https://www.paypal.com/us/fundraiser/charity/3907026

OR

Make a check payable to Monumental Impact based on the fees above with your student's name in the Memo and mail to:

Monumental Impact
55 Adams Street
Monument, CO 80132
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Emergency Phone Number*
Alt. Phone Number*
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe. If prescribed an inhaler or EpiPen, please explain any instructions and have them bring one in case of emergency.
NOTE: We do not have an inhaler or EpiPen onsite.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Monumental Impact and Bearbotics during the selected program. In exchange for the acceptance of said child’s candidacy in this program, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Monumental Impact, Bearbotics and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected program sessions.

In case of injury to said child, I hereby waive all claims against Monumental Impact. Including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities involving mechanisms and moving objects. The types of injuries involved in this program include, but are not limited to, the risk of bruising, eye injuries or torn skin.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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