Student Registration

Student Registration

All funds received will be put towards programs and capabilities 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 Name Last Name
Grade*
Entering grade for 2022-2023 school year
School*
Examples: LPMS, BCES, LPHS
Parent/Guardian
Name*

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

Descriptions of sessions are available on our website.
Sessions Available*
prevnext( X )
DIY Drone WorkshopDec 3rd (Sat) 2:00-4:30PM. Entering 6th Grade or higher. Session price includes the drone. Participants take home the drone they build which is valued at $175.
$200

Soldering / Electronics WorkshopDec 3rd (Sat) 3:00-4:30PM. Entering 7th Grade or higher. Participants take home the item they solder and build.
$30

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 Name Last 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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