CyberBrick: Make and Take Workshop Registration
Register for our CyberBrick: Make and Take Workshop by entering your details and selecting your preferred date below. An individual child can be registered for multiple sessions with one submission, but please fill out a separate registration for each child/participant.
Participant Name
*
First Name
Last Name
School Attending
*
Age
*
Grade
*
Please Select
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Home Zip Code
*
Does the student have any medical needs/special considerations?
*
Yes
No
Allergies (food, environmental, medication):
Medications Needed During Camp:
Medical Conditions or Special Considerations:
Parent or Guardian Name
*
First Name
Last Name
Parent or Guardian Email Address
*
example@example.com
Parent or Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Relationship
*
Is there an additional emergency contact different from parent or guardian listed above?
*
Yes
No
Emergency Contact Name
First Name
Last Name
Emergency Contact Email
example@example.com
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship
Class dates (choose):
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next
( X )
CyberBrick: Make and Take Workshop: M-T, June 15-16, 9AM-12PM (Soccer Bot)
(M/R)
$125.00
$
125.00
CyberBrick: Make and Take Workshop: W-Th, July 8-9, 1PM-4PM (Cuby)
(M/R)
$125.00
$
125.00
CyberBrick: Make and Take Workshop: W-Th, July 15-16, 9AM-12PM (CyberBrick Truck)
(M/R)
$125.00
$
125.00
Payment Methods
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
Should be Empty: