GO-Bots Application

"*" indicates required fields

Participant Information

Name*

First Last

Date of Birth*

Gender*

* Please have students select: Male, Female, Other

Address*

Street Address City Postal Code

Telephone*

Primary Parent Contact Information

Primary Parent Name*

First Last

Relationship*

(ie. Mother, Father)

Address (If different from above)

Street Address City Postal Code

Primary Contact Work Phone

Primary Contact Home Phone

Primary Contact Cell Phone

Primary Contact Email*

Other Contact Information

Other Contact Name

First Last

Relationship

(ie. Mother, Father)

Other Contact Address (if different from above)

Street Address City Postal Code

Other Contact Work Phone

Other Contact Home Phone

Other Contact Cell Phone

Other Contact Email

Additional Information

Student's Current School*

Full Name of your Current School Classroom Teacher*

School attending this upcoming school year*

Grade entering this upcoming September*

Please tell us why you would be a good candidate for this program.*

Please select the preferred section. This is not guaranteed but we will do our best to accommodate the preference

Upload Most Recent Report Card*

Max. file size: 5 MB.

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All students in Grade 4 eligible

For the 2024-2025 school year

Participant Information

Primary Parent Contact Information

Other Contact Information

Additional Information

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