Mad Science is Sponsored by the Windham Recreation Dept
Join Mad Science for a hands-on After School program all about Robots! Radical Robotics is fun for girls and boys alike. Through the integration of exciting modular robotics learning systems and various types of robots children will discover how robotic devices use sensors to learn about their environment and how people use robots to get work done. They will explore the mechanical aspects of robots, circuitry, and programing. Discover circuits using squishy conductive dough and snap together circuit-board modules to perform exciting functions. Spend a class building Moss Robotics Systems and navigating BeeBots and ProBots through obstacle courses. Finally children will have the opportunity to build their very own robot to take home with them. Mad Science has spent years developing robotics programs for elementary students; we can confidently say that we have robotics down to a science!
Location: Windham Primary School
Day: Tuesdays
Dates: 9/23 – 10/21/14 (5 Weeks)
Time: 3:00-4:00 pm
Room: Art Room #1
Grades: K-3rd
Cost: $67
Minimum/Maximum: 12/18
Registration Deadline: 9/19/14
Register online at www.windhammaine.us or call 892-1905 today!
Mad Science of Maine
105 Main Street, South Portland, ME 04106
Ph: 207-878-2222 Email: taryn@madsciencemaine.com
*Please send permission slip to your child’s teacher indicating that your child will be attending the Mad Science Program.
Name of Program__________________________________Session_______________________________
Participant’s Name_________________________DOB_____________AGE_____GRADE_____M/F____
Parent Name____________________________________________________________________________
Address _______________________________________________________________________________
E-Mail______________________________Phone (H)______________________(W)_________________
Does he/she have any allergies, physical or mental impairment that could interfere with his/her participation? If YES Please specify_______________________________________________________
Is he/she on any prescribed or over the counter medication?______________________________________
Emergency Contact Person___________________________________________Phone________________
Insurance Company Name_______________________________Policy/Group_______________________
I (Parent/Guardian)___________________________________give my son/daughter permission to participate in the Town of Windham Parks & Recreation Dept. program and agree to all responsibilities in case of accident. The obligation to inform our department of any special medical or behavioral conditions is yours. The Town assumes no responsibility to make any further inquiry beyond that.
For me and for the child, the undersigned agrees and understands that participation in recreation may result in injury to my child in the Town of Windham Parks & Recreation Dept. program. I hereby assume all risks in connection with my child’s participation in such activities and hereby release, indemnify, forever the Town of Windham Parks & Recreation Dept., along with their representatives, agents, affiliates, officers, directors, servants, employees, successors, and assigns from all liability for any injuries, damages, claims or actions in law or inequity, and from all claims by me, my child, my child’s estate, my family, heirs, and assigns arising in any way, directly or indirectly, from my child’s participation in the Town of Windham Parks & Recreation Dept. programs.
The undersigned authorizes the Town of Windham Parks & Recreation Dept., it’s agents, or any independent contractors working on it’s behalf to call for any medical care that they deem appropriate or necessary for the participant during the course of the program. I further authorize any medical personnel to administer any required emergency medical treatment in the event that a parent or guardian cannot be reached by telephone numbers provided on this form, the undersigned, further realized that any student caught with drugs or alcohol will be suspended from the program without refund at the discretion of the Town of Windham Parks & Recreation Dept. The Town of Windham Parks & Recreation Dept. reserves the right to refuse services to the child if the administration deems necessary for the safety of my child and other program participants, or staff. I have carefully read the following release language and completely understand its content. I sign this document for myself as an individual and as Parent or Guardian of this child.
Parent/Guardian__________________________________________________Date__________________
Town of Windham Parks & Recreation Dept. Registration Form
8 School Road, Windham ME 04062
Monday - Friday 8:00am – 4:00pm Phone 892-1905/Fax 892-1923
www.windhammaine.us
Registration is secured once payment has been received