31Bricks Registration Form

This form can be filled out electronically on this page, or you can download and print the form as a Word document using the button below.

The registration and authorization forms are general 31Bricks Program forms and only need to be filled out by new participants or if/when participant information has changed.

Download Registration Form

PLEASE NOTE: Submission of the forms does not constitute enrollment. We will contact you using the information you provide to confirm registration and arrange payment. If you are not submitting electronically, you can bring the forms the first day your child/ren participate/s. If you choose to print the forms and all the needed information fits, you can use one form for more than one child.

* Indicates required field

Child Name *

First

Last

Nickname *

Gender *

Age *

Date of Birth (MM/DD/YYYY) *

Parent/Guardian's Name *

First

Last

Primary Phone *

Secondary Phone *

Email *

Parent/Guardian's Name *

First

Last

Primary Phone *

Secondary Phone *

Email *

Person(s) authorized to pick up child *

Person(s) NOT authorized to pick up child: (legal documentation must be attached if a parent is listed here) *

EMERGENCY CONTACTS:

List two people who DO NOT live at the same address or have the same phone number as the parent/guardian

Emergency Contact 1

Name *

First

Last

Relationship to child *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Phone *

Secondary Phone *

Emergency Contact 2

Name *

First

Last

Relationship to child *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Primary Phone *

Secondary Phone *

EMERGENCY INFORMATION:

List any medical conditions or allergies your child may have and any prescription drugs your child may be taking: (Staff cannot store or administer medication) *

List all critical and pertinent information which will help staff to better accommodate and understand your child *

Second Page:

The second page of the registration form requires a signature. You can print the form using the download link below, or sign a copy of the form provided on the first week of camp.

I acknowledge I have received the 31Bricks Brick Builder Authorization Form, 31Bricks Builder Rules and understand that I am responsible for the information it contains.
I will not hold 31Bricks or their principals, officers, employees, agents and representatives, liable, in case of accident or injury to my child.
I give permission for my child to attend and participate in 31Bricks Brick Builder Programs and camps
during the week(s) he/she is registered.
CONSENT TO USE PHOTOGRAPHS: I understand that photographs may be taken of me and/or my child at any 31Bricks Brick Builder, class or program for publications used in promoting our programs, classes or events.

Signature of Parent/Guardian:

Date Signed:

I UNDERSTAND EACH PROGRAM IS FIRST COME, FIRST SERVED & THAT ONLY FULL PAYMENT OF THE PROGRAM FEE ALONG WITH COMPLETED AUTHORIZATION FORM AND REGISTRATION FORM GUARANTEES MY CHILD A SPACE FOR THAT PROGRAM.

31BRICKS RULES

1. HAVE FUN!

2. RESPECT EVERYONE’S CREATIONS!!

3. TAKE ONLY WHAT YOU NEED! THERE ARE NO “PARTS HOGS” IN THIS CLUB!

4. PLEASE TREAT OUR BRICKS WITH RESPECT:

NO THROWING BRICKS
NO CHEWING ON BRICKS
NO STEPPING ON BRICKS

5. HELP CLEAN UP WHEN ASKED!
NO “CHUNK DUMPING”

6.   Please DON’T bring LEGO bricks from home!

7.   Let’s keep it rated "E" for everyone!!

Contact 31Bricks (Sara Reczek) at (585) 290-8102 or email: [email protected].
Since we use our LEGO® supplies in programs throughout the year, students do not take projects or pieces home unless specified.
LEGO®, WeDo™ is a trademark of the LEGO® Company which is not affiliated with 31Bricks.
www.31bricks.com

I agree to receiving marketing and promotional materials *

Submit