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Big Bad Bot Builders Application
Grades 4 to 6 girls and boys eligible
For the 2021-2022 school year
Date of Birth*
Telephone*Primary Parent Contact InformationPrimary Parent Name*
Relationship*(ie. Mother, Father) Address (If different from above)
Primary Contact Work PhonePrimary Contact Home PhonePrimary Contact Cell PhonePrimary Contact Email*
Other Contact InformationOther Contact Name
Relationship(ie. Mother, Father) Other Contact Address (if different from above)
Other Contact Work PhoneOther Contact Home PhoneOther Contact Cell PhoneOther Contact Email
Additional InformationStudent's Current School* School attending this upcoming school year* Grade entering this upcoming September* Please tell us why you would be a good candidate for this program.*