Fab Lab Roxbury Workshops: Application Form [Spring 2018]

  • Personal Information

  • If the participant is a Minor who 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.
  • If yes, please list below along with medication taken to alleviate allergies or medical condition.
  • Fab Lab Roxbury Workshop(s) Registration

  • Please select which of the following sessions of the Fab Lab Roxbury Workshop(s) the participant would like to participate in.

  • 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 local area participants throughout the Spring of 2018 as strictly a not-for-profit educational opportunity through the Roxbury Innovation Center (RIC) by Mbadika, Inc., AutoDesk, and the Venture Cafe Foundation.

    I am acknowledging that I am releasing Mbadika, Inc., AutoDesk, the Venture Cafe Foundation, the Fab Lab Foundation, Boston Public Schools, 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 Mbadika, Inc., AutoDesk, and the Venture Cafe Foundation in order to provide an invaluable, hands-on educational experience for to local area students. Hence, I agree to pay any required participation fee or forfeit an opportunity to participate in a Fab Lab Roxbury Workshop if selected.

    Further, I understand that if a participant 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 permission to Mbadika, AutoDesk, and the Venture Cafe Foundation, and their affiliates to film and otherwise document the aforementioned applicant's participation for promotional and commercial purposes.

    By typing your 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.
  • This field is for validation purposes and should be left unchanged.