Mechatronics Robotics Academy Student Information Form

Premier Mechatronics Robotics Academy Student Information Form

For the 2024-2025 school year

Please note – this program is for students entering grades 9-12

"*" indicates required fields

Participant Information

Name*

First Last

Male/Female/Other*

Current Grade*

This program is for students entering grades 9-12 in Sept 2024.

Date of Birth*

Student's Email*

Primary Parent Contact Information

Primary Parent Name*

First Last

Primary Contact Telephone*

Primary Contact Email*

Primary Contact Work Phone

Primary Contact Home Phone

Primary Contact Cell Phone

Primary Contact Address*

Street Address City Postal Code

Other Parent Contact Information

Other Parent Name

First Last

Other Parent Telephone

Other Parent Email

Other Parent Work Phone

Other Parent Home Phone

Other Parent Cell Phone

Other Parent Address if different from above

Street Address City Postal Code

Additional Information

Student's Current School*

School Location*

ie: West Vancouver, North Vancouver, etc.

School Attending this upcoming September*

Are you enroling in any of the following programs?

Other Specialty Program (i.e. FAST, YELL, YTT, etc)

Please list the program name if "Other" selected above

Please tell us why you would be a good candidate for this program (to be written by the student). Include your experience with Robotics and the number of years you have been involved.*

Upload Additional Documents

Drop files here or

Max. file size: 5 MB.

*Please note: multiple additional documents can be uploaded

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Premier Mechatronics Robotics Academy Student Information Form

For the 2024-2025 school year

Participant Information

Primary Parent Contact Information

Other Parent Contact Information

Additional Information