Please enable JavaScript in your browser to complete this form.Student DetailsStudent's Name *FirstLastEmail *EmailConfirm EmailDate of Birth *Student's PhoneStudent's Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeGrade in September 2023 *Grade 8Grade 9Grade 10Grade 11Grade 12OtherACCN Program(s) you were/are in: *NPHP YouthJava Intro to CodingWeb DevelopmentAdvanced Java CodingIntro to Computer Aided Design (CAD)None of the aboveDo you have any experience with Robots/Robotics? *YesNoBriefly describe your experience. *Do you have experience in any area listed below? *Coding/ProgrammingCAD (Computer Aided Design)AnimationVideo EditingWritingCreating PresentationsComfortable using toolsNone of the aboveParent DetailsParent's Name *FirstLastParent's Email *EmailConfirm EmailRelation to Student *MotherFatherGuardianRegister another Parent *YesNoParent's Name #2 *FirstLastParent #2 Email *EmailConfirm EmailRelation to Student *MotherFatherGuardianI/We want my/our child to be part of ACCN Robotics Team because: *If my/our child is selected for ACCN’s UMOJA ROBOTICS program, I/we agree that: *I/we will be committed to supporting the success of my child and the teamI/we will ensure that my child abides by the ACCN’s Code of ConductI/we will contact ACCN about any concerns regarding my child in the programI agree to the conditions outlined above: *YesNoDateSubmit
