VEX Robotics Club Application Form

High School Student Membership

Student Information

Name(Required)

First Last

Birthdate(Required)

Grade Level(Required)

Student Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

School and Club Location

Name of High School(Required)

Preferred Meeting Location(Required)

Parent/Guardian Information

Parent/Guardian Name(Required)

Relationship to Student(Required)

Parent Phone Number(Required)

Parent Email Address(Required)

Emergenct Contact (if different from above)

Emergency Contact Name

Phone Number

Relationship to Student

Section Break

1. Why are you interested in joining the VEX Robotics Club at Southern Crescent Technical College? (50–100 words)(Required)

2. Do you have any prior experience in robotics, programming, electronics, or engineering?(Required)

Yes

If yes, please explain briefly:

3. Which areas of robotics interest you most? (Select all that apply):(Required)

Building & Mechanical Design

Programming & Coding

Electrical Systems & Sensors

Driving & Competition Strategy

Team Leadership & Organization

Outreach, Media & Marketing

Other

Availability

Please list any known schedule conflicts (sports, work, etc.):

Commitment

I understand that participation in the Southern Crescent Technical College VEX Robotics Club involves a commitment to regular attendance, teamwork, and active participation. I agree to uphold the club’s values and contribute positively to our projects and competitions.

Electronic Signature Acknowledgment By typing your name below, you acknowledge and agree that your electronic signature is the legal equivalent of your manual signature. You further agree that the information provided is accurate to the best of your knowledge and that you consent to conduct business electronically.

Student Name(Required)

Date

Parent's Name(Required)