FAB LAB ROXBURY

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.

The Roxbury Innovation Center (RIC) LEGO Robotics Program is a collaboration with the Timothy Smith Network (TSN), Northeastern University College of Engineering (NEU COE), and the Roxbury Innovation Center (RIC).

It is an entirely volunteer-run program.

Therefore, we require participants to commit to participating in the entire course, which includes (9) Thursday Evening Sessions from February 1st through April 5th, 2018 at the Roxbury Innovation Center.

I understand that participation in a Fab Lab Roxbury Workshop is voluntary and the program is being offered to local area students throughout Spring 2018 as strictly a not-for-profit educational opportunity through the Roxbury Innovation Center (RIC) by Mbadika, Inc., Timothy Smith Network, Northeastern University College of Engineering, and the Venture Cafe Foundation.

As the parent or legal guardian of the aforementioned applicant, if selected, I am releasing Mbadika, Inc., Timothy Smith Network, Northeastern University College of Engineering, 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., Timothy Smith Network, Northeastern University College of Engineering, 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 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 permission to Mbadika, Timothy Smith Network, Northeastern University College of Engineering, 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.