LEGO® Robot Rumble Registration Form

Thank you for your interest in LEGO® Robot Rumble at The Discovery. To register, please complete the form below. One registration form is required for each participant.

Participant Information
Participant Name*
First Last
Participant’s Age*
Are you a member of The Discovery?*
- Yes
- No
Members (Ages 5-8) - Select your date...*
Members (Ages 9-12) - Select your date...*
Nonmembers (Ages 5-8) - Select your date...*
Nonmembers (Ages 9-12) - Select your date...*
Special needs?
Guardian Information
Guardian Name*
First Last
Email*
Home Phone
Mobile Phone
Primary Phone
- Home
- Mobile
How did you hear about LEGO® Robot Rumble at The Discovery?*
- Flyer
- Website
- E-mail
- Social media
- News article/story
- From a friend
Emergency Contact/Authorized Pick-up
Would you like to add an additional authorized pick-up person?*
- Yes
- No
Additional Authorized Pick-up
Authoized Pick-up Person
First Last
Authorized Pick-up Person's Phone
Authoized Pick-up Person's Relation

Please describe the authorized pick-up person's relation to the participant.
Hidden
Would you like to add an additional emergency contact?*
- Yes
- No
Additional Emergency Contact
Emergency Contact Name
First Last
Emergency Contact Email
Emergency Contact Home Phone
Emergency Contact Work Phone
Emergency Contact Mobile Phone
Emergency Contact Primary Phone
- Home
- Work
- Mobile
Payment Information
Registration Total
$0.00
Credit Card*
Card Details
Cardholder Name

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•
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•
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•
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LEGO® Robot Rumble Registration Form

Participant Information

Guardian Information

Emergency Contact/Authorized Pick-up

Additional Authorized Pick-up

Additional Emergency Contact

Payment Information