See All Programs Luria Academy Robot Builders After School Class $416.00 Start Date Booking Time Choose Class Date & Time Fill In Student Information Child’s Full Name * Child’s Preferred Pronoun(s) * Select an option... She/Her He/Him They/Them Other (please provide additional info in “Accommodations” below) Child’s Age * Child’s Date of Birth (MM/DD/YYYY) Friends If your child has any friends that you would like them to be placed with, please add their names here How Can We Work Better With Your Child If you have any suggestions on how our teachers can work better with your child, please let us know here. Accomodations If your child requires any special accommodations, please place them here. Epi Pen * Does your child require an Epi Pen or inhaler? If so, you MUST bring it on the day of the session. Yes No Allergies * Does your child have any allergies? If so, please list them here Pick Up * Please list the names and numbers of people approved to pick up your child Pick Up (Section 2) * Does your child have an individual in their life that has a restraining order or similar order of no contact? If so, please provide additional information on that person. Accept Terms & Conditions Terms * Please click below to read the full Terms & Conditions: View Terms & Conditions Close Overlay I agree to the following terms: I represent that I am the parent or legal guardian of the child I am enrolling, who is participating in a session, program or other event (hereinafter the “Program”) by or with Brooklyn Robot Foundry LLC (hereinafter “The Foundry”). I hereby certify that my child is in good health and that my child has no limitations that with or without a reasonable accommodation would preclude his/her safe participation in the Program. I hereby give my authorization and approval for my child’s participation in any and all of the activities of the Program. I further acknowledge and agree that participation in the Program involves constructing working robots other mechanical devices and, further, that these activities are inherently hazardous and that risks include physical injury and property damage. Specifically, my child will be using tools and electrical components in the Program including screwdrivers, magnets, batteries, small metal and plastic pieces, and wires. I further acknowledge that the above list is not inclusive of all possible risks associated with the program and that the above list in no way limits the extent or reach of this release. By enrolling my child in the Program, I agree to release, indemnify and hold harmless on behalf of myself, my heirs, representatives, executors, administrators, and assigns The Foundry, its officers, agents and employees from any cause of action, claims, or demands of any nature whatsoever, including but not limited to a claim of negligence, which I my heirs, representatives, executors, administrators, and assigns may now have or have in the future against The Foundry, on account of any personal injury, property damage, death or accident of any kind arising out of or in any way related to my child’s enrollment in the Program. I understand that the class may be delivered online and will be recorded for quality and liability purposes. I understand that no footage of my child will be used for any purpose including marketing, advertising, or similar without explicit and direct consent from me. I understand that the Foundry will be utilizing the Zoom platform with a password and storing the footage on the Zoom secure cloud server. I understand that I am forbidden to share any of the meeting information including but not limited to meeting id and password with any other individual. Through my acceptance below, I acknowledge that I have read this Agreement and understand that it includes an assumption of the risk and a release of liability. I understand that The Foundry is relying on this waiver in allowing my child to participate in the Program. Other Policies I understand that The Foundry reserves the right to ask my child to leave the session if it is determined that he/she is a danger to themselves or others or is in any way disruptive to the Program. Any decision made by the Foundry in this regard will be in The Foundry’s sole discretion. The Foundry asks that the parent/guardian disclose all pertinent information regarding their child’s past school experiences and/or behavior so we may help you decide if our session is appropriate for your child. If the parent withholds information pertaining to special needs, behavioral, physical or other and it is determined that The Foundry is not appropriate for your child, refunds will not be given. If we find out that your child does not meet the age requirements for the session, your child may be asked to leave and no refund will be made. Similarly, if your child is asked to leave the session for any reason, no refund will be made. Upon Entrance to the Session I agree that my child cannot enter the session until this form, application have been signed this agreement. I have read and understand the above information and agree to its terms. Intellectual Property Acknowledgement I understand that any project I or my child make, see, or have / has explained to me / my child by the teachers at Brooklyn Robot Foundry is based on work product and intellectual property owned and developed by Brooklyn Robot Foundry over many years. Moreover, I understand that the materials, including but not limited to handouts and images, provided in connection with any project or course at Brooklyn Robot Foundry, whether provided or displayed in digital or physical copy, are subject to copyright protection and are not to be copied without authorization. I acknowledge and agree that Brooklyn Robot Foundry has a legitimate business interest in the protection of the techniques, methods, and projects disclosed to me in the classes or other programs at Brooklyn Robot Foundry. I understand, acknowledge, and agree that I am prohibited from using or disclosing any of these techniques, methods, or projects for monetary gain without Brooklyn Robot Foundry’s express prior written consent. I understand, acknowledge, and agree that the course and project materials provided by Brooklyn Robot Foundry are the copyright of Brooklyn Robot Foundry and that I may not copy, reproduce, distribute, perform, or display such works, or create derivative works from said works, without Brooklyn Robot Foundry’s express prior written consent. I agree to the terms and conditions Photo and Video Release * Please click below to read the Photo & Video Release: View Photo & Video Release Close Overlay I represent that I am a custodial parent or legal guardian of the child I am enrolling, and I hereby grant permission to Brooklyn Robot Foundry to photograph or record on video tape all class activities and to use any photograph or video in which my child appears in for promotional literature, displays or any other format representing Brooklyn Robot Foundry to the community including the Brooklyn Robot Foundry website. I release all rights to such. I agree to the photo & video release I DO NOT agree to the photo & video release Luria Academy Robot Builders After School Class quantity — OR — Book Now!