Fillable FIRST LEGO Team Application for New League Explore (Girl Scouts of Eastern Missouri)

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FIRST LEGO Team Application for New League Explore (Girl Scouts of Eastern Missouri)

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LKD
6/3/2020
Team Application
for New
FIRST
®
LEGO
® League Explore Teams
(Formerly FLL Jr.)
Girl Scouts of Eastern Missouri Inc. (Girl Scouts) is pleased to offer the opportunity for girls to participate in the
FIRST® LEGO® League Explore program during the 2020–2021 season. The Coach, as named in this Application,
acting on behalf of the Team, agrees to the following. Please sign and return original copy to Girl Scouts of
Eastern Missouri.
Team Commitments:
• We understand that we are an official Girl Scout Troop and are aware of Girl Scout Troop
requirements, such as participating in the Cookie Program and Fall Product Program.
• We understand that we are required to attend a competition, either an Expo or Qualifier,
and that failure to do so will result in a $100 fine.
• We understand that if we do not continue with the program it is our responsibility to
return the equipment to Girl Scouts of Eastern Missouri.
• We understand the main season of the FLL Explore program runs January 2021–March 2021 and agree to
participate in an Expo in spring 2021.
• We understand that the season may be extended through the World Championships in April 2021, should
our team advance to that level.
• We agree GSEM will provide team t-shirts with appropriate sponsor logos for up to six girls and two
coaches and to sign up for the new coach training that will be offered in August at the Girl Scouts of
Eastern Missouri Service Center.
• We agree to participate in at least two outreach activities that will reach an additional 50 youth (examples
include school presentations or neighborhood demonstration), in order to share my team’s
accomplishments and the benefits of participating in robotics.
• We agree to maintain at least three girls on our team.
• We agree to be available for a site visit from Girl Scouts or GSUSA staff during the grant period, which
goes through April 30, 2021.
• We agree to clearly identify ourselves as Girl Scouts in any recruitment event, media event, or competition
and to abide by Girl Scout troop trip guidelines if travelling outside the Council boundaries.
• We understand that our team is required to participate in one FLL Explore Exposition, regardless of how
far the team has progressed.
• We agree to work with Girl Scouts’ Communications Department on any team publicity.
LKD
6/3/2020
• We agree to return all team equipment to Girl Scouts upon completion of the program, if we do not plan to
continue in robotics, or we move to another level.
• We agree to keep equipment clean and in good condition for the duration of the program and to use it only
in the manner in which it is intended for this program. Kit pieces must be organized separately and
returned to Girl Scouts in an organized fashion.
• We understand our team will be asked to volunteer at promotional events Girl Scouts hosts, and we are
willing to help out as much as we can.
• We understand that the full cost of participation for our Robotics Team is $395. This price includes
registration fees, equipment and other team materials. Girl Scouts of Eastern Missouri, with generous
support, is covering 60% of the team’s expenses ($237).
• We agree to pay 40% of the cost ($158) by August 3rd, 2020 for our team to participate. Our team
can participate in approved money earning activities, such as the Girl Scout Cookie Program, to help raise
funds for the team. Activity scholarships are available if there is a need. Please see attached form.
Adult Commitments:
• We agree to provide at least one adult volunteer to help at one FIRST event (Expo or Qualifier).
• We agree to provide a secure location for team equipment to be stored until it is returned to Girl Scouts.
• We agree to provide the following girl / adult ratio for each team:
Two adults to every 12 girls in grades K-1, plus one additional adult for every six girls.
Two adults to every 20 girls in grades 2-3, plus one additional adult for every eight girls.
Two adults to every 25 girls in grades 4-5, plus one additional adult to each additional 10 girls.
• We agree that during team meetings, at least one of the adults present is an adult female who is not
related to the other adult.
• We agree to have any adult working with the team complete the Girl Scouts of Eastern Missouri volunteer
application process, which includes authorization for a background screening to be conducted through
Girl Scouts and its acting agencies.
• We agree to provide all paperwork by stated deadlines, including, but not limited to surveys, amount of
time spent on project, photo releases, awards received and photos.
• We agree to notify the Girl Scout Robotics Program Manager in a timely manner if significant delays or
setbacks occur.
• We agree to submit digital photos of girls and adults engaged in the program activities by March 31, 2021.
• We agree that the two adult coaches will comply with the USFIRST Youth Protection Program.
Coach Signature _____________________________________________________________
Date ______________
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LKD
6/3/2020
Groups of Girl Scouts interested in competing in the FIRST® LEGO® League Explore program for the
2019-2020 season should complete the form below and return by July 3rd to:
Lauren Kornegay Dollar
Girl Scouts of Eastern Missouri
2300 Ball Drive
St. Louis, MO 63146
314-214-3044 fax
314-592-2376
Support is awarded on a first-come, first-served basis until all available positions have been
filled or the deadline passes.
FLL Explore teams are for girls in 2nd-4th grade (ages 6-10)
Adult Coach (does not have to be troop leader, must be/become registered Girl Scout)
Name __________________________________________________________________
Address ________________________________________________________________
City _______________________________ State _____ Zip ______________
Day Phone ____________________________ Evening Phone ____________________
Adult E-mail _____________________________________________________________
Ethnicity ______________________________ Currently registered (Y/N) _________
Troop ____________ District/Neighborhood _________________
Additional Adult (cannot be spouse of coach, must be/become registered Girl Scout)
Name __________________________________________________________________
Address ________________________________________________________________
City _______________________________ State _____ Zip ______________
Day Phone ____________________________ Evening Phone ____________________
Adult E-mail _____________________________________________________________
Ethnicity _____________________________ Currently registered (Y/N) __________
Troop ____________ District/Neighborhood _________________
LKD
6/3/2020
Team Members (maximum team size is 6)
Girl Name and Address
2020-2021
grade
School
Troop
Email
Phone
Race/
Ethnicity
1
2
3
4
5
6
LKD
6/3/2020
Disability Information
Girl Scouts of Eastern Missouri welcomes the participation of all girls and adults and will make
reasonable accommodations to persons with disabilities. To help Girl Scouts of Eastern Missouri better
serve your child, please indicate whether the participant is in need of a reasonable accommodation in
order to fully participate in the program. The Program Manager will contact you to answer questions and
discuss accommodation requests. You can also contact the Answer Center directly at 314.400.4600 or
answercenter@girlscoutsem.org.
Do you need a reasonable accommodation? _____Yes _____No
Through community support, Girl Scouts of Eastern Missouri is able to support a limited number of
teams for the robotics season. Team support will be allocated on a first-come, first-served basis, and
Girl Scouts of Eastern Missouri will notify your team in July if they are funded.
Equipment will be issued upon receipt of the team application, team agreement, photo releases and pre-
surveys. Please note: funding is generally approved in July but the FLL Explore season does not
start until January.
Coach Signature _____________________________________________________________
Date ______________
For Office Use Only
Date Application Received ________________
Name of staff approving ___________________________________________________
Signature of staff approving _________________________________________________
Date __________
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FIRST LEGO Team Application for New League Explore (Girl Scouts of Eastern Missouri)

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Completed 9 May 2021

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