BEAM Saturday Academy Application

Robotics Program

2024/2025
Student's First Name*
Middle Name
Student's Last Name*
Last Name
Student's Phone Number

Area CodePhone Number
Student's E-mail *
Name of Parent/Legal Guardian*

First NameLast Name
Parent/Guardian Email*
Parent/Guardian Phone Number*

Area CodePhone Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender*
Race*

BlackHispanicAsianNative AmericanCaucasianOther
Name of Current School*
Current Grade Student Is In:*
Student Health Form
Does you child have any allergies we should be aware of or require special care? (if none, type "None")*
In case of an emergency whom may we contact?
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
In the event reasonable attempts to contact the above listed phone numbers have been unsuccessful, I hereby give my consent to the administration of emergency medical treatment by any licensed physician or dentist and to transport the child to any reasonably accessible hospital facility.
Signature of Parent or Guardian*

Clear
Media Release Form
Dear Parent/Guardian,

During the BEAM Saturday/Club/Summer Programs, your child will be involved in various projects and activities. We use BEAM student photographs and video for our promotional literature, social media, annual reports, and webpage but not for the endorsement of, or service to, any entity other than programs of BEAM and it's immediate affiliates. BEAM uses the utmost discretion when using a child's likeness.

If you consent to this, please fill out this portion of this form. Thank you for your cooperation.

"I hereby grant BEAM the right to record my child’s likeness on film, video, photograph, and in writing for promotional use, newsletters, publications, and social media."
Parent Signature*

Clear
Code of Conduct
1. Students must treat staff and their peers with respect. The use of foul language or physical or verbal fighting will not be tolerated.

2. Students must return any materials from instructors in good condition. Students must be careful not to damage site property or program materials.

3. Students may leave the classroom only with permission of the instructor. It is recommended that students use the rest room prior to class. Only one student will be permitted to use the rest room at a time.

4. Students are expected to dress in a manner appropriate for school. Clothing, hats and attire bearing an expression or insignia which is insulting or obscene or which advocates racial or religious prejudice or is offensive in any way or bearing an expression or insignia of drug or alcohol or tobacco product is prohibited.

5. Weapons and illegal drugs are strictly prohibited.
Signature*

Clear
Should be Empty:

Robotics Program

Student Health Form

Media Release Form

Code of Conduct