Battle Bots Summer Camp Enrollment

Battle Bots Summer Camp Enrollment

Please complete the following form to enroll your child in the Builder’s Club Battle Bots Summer Camp. All information provided will be kept confidential and used solely for the purpose of the Program. This camp is made possible by funding from Perry County Jobs and Family Services and HAPCAP.
Program Information
The Battle Bots Summer Camp is an exciting and innovative opportunity for young enthusiasts to dive into the world of robotics, engineering, and competition. Hosted by experienced instructors and engineers, this camp provides hands-on experience, teamwork opportunities, and a chance to unleash creativity in designing and building combat robots.

The program culminates in a thrilling final tournament where teams compete head-to-head in an arena-style battle. Participants showcase their robots' capabilities, teamwork, and strategic prowess in an electrifying showdown.

Why choose Battle Bots Summer Camp?

- Engage in exciting academic enrichment activities that keep learning fun and bridge any summer gaps.
- Dive deep into science and math with practical, real-world applications.
- Participate in challenges that build your knowledge and skills.
- Develop character and teamwork through collaborative projects.
- Gain essential skills for future employment through integrated learning activities.
- Enhance your personal talents and discover new interests.
- Explore potential career paths in robotics and engineering.

Don't miss out on this action-packed camp that combines education with exhilarating fun. Sign up now and prepare for a summer you’ll never forget at Battle Bots Summer Camp!

Participant Eligibility
Age 12 - 18
Ability to work with a partner for the duration of the program

Camp Schedule
Ages 12-14:
Monday - Friday
9:00am - 12:00pm

Ages 15-18:
Monday - Friday
1:00pm - 4:00pm

Camp Sessions
July 8 - 19
July 22 - August 2

Cost to Attend

FREE!
Participant Information
Session*

Session 1 (July 8 - 19)Session 2 (July 22 - August 2)
Participant's full name*
Participant's date of birth*

MonthDayYear
Date
First additional participant's full name
First additional participant's date of birth

MonthDayYear
Date
Second additional participant's full name
Second additional participant's date of birth

MonthDayYear
Date
Emergency contact information
Full name*
Relationship to participant(s)*
Phone Number*
Please enter a valid phone number.
Email address*
example@example.com
Please list any special requirements, allergies, or medical information that we should be aware of for the participant(s):
Authorized to pick up the participant(s):
I, the undersigned parent/legal guardian or legal adult, give my consent for my child(ren) to participate in the 2024 Battle Bots Summer Camp. I acknowledge that I have read and understood the program details and agree to abide by the rules and regulations set forth by the Somerset Builder's Club. I also understand that photographs may be taken during the program for promotional purposes, and I give my consent for my or my child's image to be used in such materials.
Name*
Name of signer
Signature*

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Date*

MonthDayYear
Date

Somerset Builder’s Club Photo Release Form
Somerset Builder’s Club Photo Release Form
I hereby authorize the Somerset Builder’s Club (SBC) and its representatives to take photographs and/or video recordings of me and/or my child, and to use these photographs and/or video recordings for any lawful purpose, including but not limited to publicity, advertising, and web content.

I understand that my and/or my child's participation in any photograph or video does not entitle me or my child to compensation, and that all photographs and videos become the property of SBC. I acknowledge that SBC may choose not to use any or all of the photographs and/or video recordings at its sole discretion.

I waive the right to inspect or approve any finished product in which my and/or my child's image appears, and I agree that SBC is not responsible for any misuse or distortion of the images.

I understand that by signing this release, I am giving up my and/or my child's legal rights and remedies related to the use of any photographs and/or video recordings taken during the SBC Summer Youth Camp.

I have read this release form, understand its contents, and agree to its terms.
Name*
Name of signer
Signature*

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Date*

MonthDayYear
Date

Prevention, Retention and Contingency Program (PRC) Application

Self-Declaration
If you are not registered to vote where you live now, would you like to apply to register to vote?

Yes, I want to register to vote.No, I do not want to register to vote.
Registrant's name*
Parent or Guardian
Social Security Number*
Address*

Street Address

Street Address Line 2

CityState

ZIP Code
Job and Family Services Case Number
Phone Number(s) where you can be reached*
For up-to-date information regarding JFS services and events, please provide your email address:
example@example.com

Complete the chart below for EVERYONE living in your home, including YOURSELF. (Use next text box if more spaces are needed.)*

	Name	Relationship to Registrant	Birth Date	Age	Social Security Number	Current Grade in School	Employer's Name or School	Income Amount
1
2
3
4
5
6

Overflow from previous question
Please read this statement carefully and respond below:

I reside in Perry County and have a child younger than 19 years of age in Ohio. All members of my household are citizens or qualified aliens. I am not in debt to the Department of Job and Family Services for an OWF or PRC overpayment due to fraud. I am not an unmarried parent under 18 who is not attending school or not living in an adult-supervised living arrangement. No one in my household is a fleeing felon or probation /parole violator. No one in my household is failing to cooperate with the Child Support Enforcement Agency in establishing paternity or securing child support. No one in my household has been found to have fraudulently misrepresented their residence in order to obtain benefits in two or more states. I understand that this is a special program based on available funding, and an eligible determination does not guarantee that I will receive the services/product. I agree to allow JFS employees to utilize pay verifications received within the last year for auditing this self-declaration statement.
I agree with the above statement (it is correct/true for me).I disagree with the above statement (it is not correct/true for me).
The information provided above is complete and correct to the best of my knowledge and belief.
Signature*

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Date*

MonthDayYear
Date

Important Contact Information for Parents
Dear Parents,

As part of our commitment to ensuring the safety and well-being of your children while they attend our day camp, we are providing you with the following important contact information:

Perry County Health Department:
Telephone Number: (740) 342-5179

Perry County Children Services Agency:
Telephone Number: (740) 342-3836

Please note that you may use these telephone numbers to make a complaint regarding any concerns or issues related to our child day camp. We encourage open communication and are dedicated to addressing any questions or concerns you may have.

Thank you for entrusting us with the care of your children.

Sincerely,
Builder's Club of Somerset

Please enter your email below to receive a copy of your application and get updates on its approval:*
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Battle Bots Summer Camp Enrollment

Program Information

Participant Information

Emergency contact information

Somerset Builder’s Club Photo Release Form

Prevention, Retention and Contingency Program (PRC) Application

Important Contact Information for Parents