First Lego League FLL Application and Registration Form 2017
In case of an accident or serious illness, the
school will attempt to contact me. If needed, I
understand that my child will be transported to
the nearest hospital for emergency care
treatment.
First Lego League (FLL) is a school-
sponsored function of Cornerstone for students
in Grades 4-8; ages 9-14 as of January 1, 2017.
The ideal FLL team member: likes to tinker,
discover, and learn how things work; is creative;
has fun solving problems; is interested in
science, technology, engineering, computers,
and robots; is able to stay on task.
Meeting Times: Usually Fridays (some
Thursdays) after school from 3:15 to 5:00 pm.
Occasional practice sessions may be scheduled
as needed. Team members are expected to
attend most practices and tournaments—we are
a team! All children must bring their own snack.
Registration Form
Parent/Guardian
Name:__________________________________
Please print neatly all information.
Child’s Name:____________________________
Child’s Birthdate:__________ Current Age: ___
Signature:_______________________________
Date:___________________________________
Parent’s Name:___________________________ In case of emergency, contact (print name and
phone number below):
_____________________________________
Parent’s Phone Number:___________________ _____________________________________
Email: _________________________________ Identify any medical conditions:_____________
Pick Up Location: Outside under the portico of
the Elementary Building; please do not ring the
bell to enter as the school office will be closed. Food Allergies:___________________________ _______________________________________
Fee: $75 per students; checks can be written to
“CCS” with “FLL” written on the memo line. Who will be picking up your child? ( We will not
Location: Elementary Building, CCS Library
(Please note that participating students will
assemble outside the elementary building office
and will be escorted by an adult to the library.)
Child’s T-Shirt Size ________________________
release the child to anyone other than the name listed, no
exceptions. )
The completed registration form and fee must
be submitted to the school office before your
child’s application can be considered.
The team will be limited to only 10 members,
selected on a first-come-first-served basis in the
order in which applications are received directly
by Mrs. Dawn Snellenberger (elementary office).
For more information about FIRST LEGO League,
please contact Bob Shemenski at 860-752-8675
[email protected]
_______________________________________
My child, _______________________________,
has permission to attend FIRST LEGO League on
Fridays, starting September 8, 2017, through
December 15, 2017 (tentative end date), from
3:15-5:00 pm. Please note that pick-up must be
on time and will be outside under the portico
of the Elementary Building.
Please note: No medications will be permitted
or administered during FIRST LEGO League
meetings.