Event Name : Robotics Club Permission Slip

Event Date : Saturday September 20, 2014

(We will inform you when needed on Saturdays, on short notice)
Date of receiving Permission Paper : 09/19/2014
Due date to turn in Permission Paper : 09/20/2014
Robotics Club start/end time : 10:00 Am 12:30 Pm
Location : Grand Prairie Room: 306

Students may attend up to 3 robotics competitions within the 2014-2015 school year.
Students will pay for the robotics field trips, travel and accommodations
expenses (if any) for each event, unless they make other arrangements to go/stay with parents.
Robotics club will be held 1 day each week (Tuesday) after school (3:55-4:55); however, practice days may increase mostly
on Saturday, when competition dates gets closer.
Parents have to pick up students after club within 10 minutes of release from the club.
o Robotics club will be held for 6 weeks then we will have try outs for the Robotics teams. We may only accept 10
students per team due to the FLL Rules. (At this time we only have one team.)
Three absences from scheduled meeting dates may result in losing the right to stay in robotics club. Proper excused letters
by medical personnel or legal reasons will be only accepted excuses.
Attendance is mandatory unless prior arrangement are made for the Competition.
The average grade of Math, Science, ELA and Social Studies courses drops below an 80 in one semester
WORK TOGETHER!!! Stay positive with each other. Teamwork is what wins the competitions!!

Behavior:
o Robotics club members must serve as a model student in term of their behavior and success. Members
who have more than 10 DPS points within a semester will no longer be part of the club or team.
o Team mentality involves being responsible and respectful behaviors.
o Be positive and encouranging with fellow peers; no negative or abusive or foul language language will be
tolerated.
o You need to be a team player and must be involved in all team activities this includes competitions,
which are manditory to attend.
o No games allowed during meetings, and you must put your effort into the team regardless if at home or
school.
o Parent or approved guardian must pick up on time and during competitions are not allowed to be in
competition area unless aproved by Mr. Yagli.
o If a student recieves any suspension from school, the student will not be allowed to participate in
competitions and may not be accepted to Robotics for the following semester and may subject to be
terminated from the team.


By signing this form below you are indicating that you agree to the rules and guidelines as outlined and understand the
consequences if these rules and/or guidelines if they are violated. Due this Saturday. (09/20/2014)
Signed by Parent ______________________________ Date________________________
Signed by Student______________________________ Date________________________



PARENT APPROVAL FORM FOR ROBOTICS CLUB REGISTRATION

Student Name: _____________________________________________________________________

Grade/Section: ______________

I, _________________________________(students name) pledge to abide by all district policies of the Harmony Science Academy
Grand Prairie, HPS School District handbook. I understand that I am governed by the same rules on this trip as when I am at school.
Any failure to adhere to these policies will result in disciplinary action.


(Student Signature) Grade/Section:

We (I), the parent (s)/guardian of ________________________________________ understands and agree that the trip is a school
sponsored activity and function. This release is intended to cover all injuries of every name, type, kind or nature, and personal
property damage, if any, which may be sustained or suffered from any cause connected with or arising out of, or from participation in
the listed events. I understand I am responsible for transportation costs if my child is required to return home for disciplinary
measures. I understand I will be given a choice of mode of transportation to be used.

This is to certify that my child has my permission to go on the field trip listed with this group. By signing this form parent(s) give(s)
consent to his/her child to take the transportation provided by school or teacher. Means of transportation could be any public, rental or
private vehicles driven by an adult.


_______________________________________________________ __________________
(Parent Signature) Date



Emergency Medical Release
Name________________________________________________________________
Parent/Guardian_______________________________________________________
Address______________________________________________________________
Home Phone________________Work Phone_______________Cell ______________
Emergency Contact/Phone________________________________________________________
Insurance Company/Policy/Group #_______________________________________
Doctors Name/Number________________________________________________________
Blood Type________________Known Allergies______________________________
Medication____________________________________________________________
Any Additional Medical Information__________________________________________________________
__________________________________________________________________________________________
______________________________________________
In case of emergency, I authorize emergency treatment to be administered if I cannot be contacted.
_______________________________ ________________
Parent/Guardian Signature Date