ELEVATE LEADERSHIP PROGRAM REGISTRATION FORM

OUR MISSION

Is to EXCITE, EDUCATE and ENCOURAGE
your K-12 Child to become the innovators of tomorrow.

STUDENT INFORMATION
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PARENT/GUARDIAN INFORMATION
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DEMOGRAPHICS
e3 Robotics respects and welcomes people from all backgrounds and abilities. By completing the following information (as defined by the U.S. Census Bureau), you ensure support and funding for children in our community.

PERMISSION

Media Permission
When participating in e3 Robotics activities, I (or the person I am registering) give consent to be interviewed, photographed, videotaped, or electronically imaged for the purpose of promotional materials, news releases, or other published formats. The images will be the sole property of the e3 Robotics. I hereby release and hold harmless e3 Robotics from any claim arising from the use of these images.

CHOOSE YOUR PROGRAM OR EVENT

Thank you for registering!

We have received your registration and a staff member will contact you with any questions. Should you have any additional questions for us. 

Maria Rosato, Executive Director
e3 Robotics 
1715 NC 68
Oak Ridge NC 27310
(We are located in the Center Building)
cell: (336) 493-0403

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