If the participant doesn't have a personal mobile phone number, please list the Main Phone Number of a Parent or Guardian in order to reach the participant.
Please select all that apply.
Fab Lab Roxbury Workshop(s) Registration
The Summer Vacation Program is a volunteer and RIC-run program.
Therefore, we require participants to commit to participating in the entire course, which includes Sessions from July 9th through August 14th, 2018 at the Roxbury Innovation Center.
Previous Experience and Knowledge
Emergency Contact Information
If the participant is a Minor (under 18), their Emergency Contact must be their Legal Parent and Guardian.
Fab Lab Roxbury Workshop Participant Legal Agreement
I understand that participation in a Fab Lab Roxbury Workshop is voluntary and the program is being offered to students throughout Summer of 2018 as strictly a not-for-profit educational opportunity through the Roxbury Innovation Center (RIC) and the Venture Cafe Foundation.
As the parent or legal guardian of the aforementioned applicant, I am releasing the Venture Cafe Foundation, and their representatives or affiliates from any wrongdoing during the course of this workshop. This includes any additional costs (including but not limited to transportation, food, beverages, materials, etc.) as well as personal or bodily harm accrued through participation in Roxbury Innovation Center (RIC) Fab Lab Roxbury Workshops.
In addition, I realize the program is a subsidized workshop offered by the Venture Cafe Foundation in order to provide an invaluable, hands-on educational experience to local area students. Hence, I agree to pay the required participation fee of $60 for the opportunity of participating in a Fab Lab Roxbury Workshop.
Further, I understand that if a student is found to be disruptive to the learning environment during a Fab Lab Roxbury Workshop, they will be asked not to return, continue, and complete any current or additional sessions and no refund will be given.
I also grant the Roxbury Innovation Center, and their affiliates to film and otherwise document the aforementioned applicant's participation for promotional and commercial purposes.
By typing my legal full name in the box below, I acknowledge and accept all of the above terms as well as stated.
If the participant is a minor, the legal Parent or Guardian must type their full name in the box below.
Once you have completed and signed this form please pay the fee of $60 below.
This field is for validation purposes and should be left unchanged.