LEGO® WeDo Robotics and Coding

We help children grow into creators.

$150/studentLimited space, 8 students max

Grades 1 to 3

Thursdays 4:00 pm- 5:00 pm

Dates: - 1/27, 2/3, 2/10,2/17, 2/24 and 3/3

Register online at: https://mapleshade.com/?page_id=782

LocationMunicipal Bldg., 200 Stiles Ave., Maple Shade

This fun, interactive program will introduce students to coding androbotics using the LEGO® Education WeDo™ Robotics Construction Sets.Children will learn basic programming skills, simple engineeringconcepts, and the names of the robotic components. They will work inteams of 2 on guided projects building models, attaching sensors andmotors, and using a computer to program the model’s behavior. Childrenwill gain confidence and understanding as they build and code theirrobot.

MONEY ORDER

MAIL COMPLETED FORM TO: MUNICIPAL BUILDING 200 STILES AVENUE MAPLE SHADE, NJ 08052 C/O RECREATION

PARTICIPANT NAME: ___________________________________________ DOB/AGE:______________

PARTICIPANT ADDRESS: _________________________________________________________________

PARTICIPANT CELL PHONE #: _________________________ HOME PHONE #:______________________

EMAIL: _______________________________________________________________________________

EMERGENCY CONTACT NAME: _______________________________ PHONE #:____________________

Medical History:

Is the Participant named above in good health: (circle) Yes / No

There are no refunds or make-ups after the start of a program (except if providing proof of positive COVID test). Registration is closed after session start date. If enrolling, please fill out a separate form and payment method for EACH CHILD. PAYMENT AMOUNT $______________ PAYMENT METHOD: CASH CHECK- CHECKS PAYABLE TO: TOWNSHIP OF MAPLE SHADE (program name in the memo line)

PARENT/LEGAL GUARIDAN INFO (IF PARTICIPANT UNDER 18):

NAME/RELATIONSHIP TO PARTICIPANT: ____________________________________/________________________

ADDRESS: _____________________________________________________________________________________

CELL #: ________________________________ HOME #: ________________________EMAIL:______________________________

If no, please explain any physical restrictions/consideration/allergies:

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

__________________________________________________________________________________________________________

PARTICIPANT REGISTRATION FORM

Lego-WeDo Robitics and Coding

INDEMNITY AND HOLD HARMLESS AGREEMENT

__________________________________ (Insert Participant / Guardian Name) agrees to release, indemnify and

hold harmless Built by me Stem Learning (Non Township Organization), the Township of Maple Shade and/or

the Professional Municipal Manager’s Joint Insurance Fund, and their agents and / or employees from and

against all claims, damages, losses, expenses and liabilities, including reasonable attorney’s fees and expenses in

case it shall be necessary to file an action, arising out of _____________________________________(Insert

Participant’s Name) participation in the Lego-WeDo Robitics and Coding (Insert Event) which is (1) for bodily

injury, illness or death or for property damage, including loss of use and (2) caused in whole or in part by

________________________________ (Insert Participant’s Name) negligent acts or omissions.

This indemnification and agreement shall apply in all instances whether the Built by me Stem Learning (Non-

Township Organization), the Township of Maple Shade and/or the Professional Municipal Manager’s Joint

Insurance Fund, and their agents and / or employees is made a direct party to the initial action or claim or is

subsequently made a party to the action by third party in-pleading or is made a party to a collateral action

arising in whole or in part from any of the issues emanating from the original cause or action or claim.

Description of Event: Lego-WeDo Robotics and Coding

Date of Event: Thursday 4-5 pm January 27th-March 3, 2022

__________________ ____________________________________

Date Signature of Participant / Guardian

____________________________________

Print Name

MINOR (CHILD) PHOTO RELEASE FORM

I, _________________________________________, the parent or legal guardian of

_________________________________________________ [Child] grant The Township of Maple Shade

my permission to use the photographs/videos of participation in _Lego-WeDo Robitics and Coding_

[program/event name] for any legal use, including but not limited to: publicity, copyright purposes,

illustration, advertising, and web content. Furthermore, I understand that no royalty, fee or other

compensation shall become payable to me by reason of such use.

I Agree

I DO NOT Agree

Parent/Guardian’s Signature: ___________________________ Date ________

Parent/Guardian’s Name: _________________________________________

Child’s Name: _________________________________________

Phone Number: _________________________________________