2015 Spring Competition
Team Registration
April 4, 2015
Engage your students in the application of Science, Technology, Engineering, and
Math by forming XTREME BOTS competition team(s)! Through the process of
robot building, students and student teams imagination soars to new heights. Teams advance
their skills and knowledge about robotics design as they build, present, and compete with
their own robotic creation. This hands-on project adds to team-building, planning, project
management and STEM application –all important skills essential in career preparation.
Ohio Robotics Inc. is proud to announce the XTREME BOTS Spring 2015
Competition held on Saturday, April 4th hosted by Wright State University at the
WSU Nutter Center Arena, located in Fairborn, Ohio. Doors open at 8:00 am.
Schools may maximize student learning with multiple teams. Team participants require a
three student minimum. Although there is no maximum number for team participants, four to
six students are recommended per team. Students may only register for one team in the
competition and only one robot per team entry. Prizes will be awarded for First, Second, and
Third Place as well as merit awards for Documentation, Engineer Design, and Sportsmanship.
For complete information visit our website at www.ohiorobotics.org.
Your Team commitment:
 Each team will attend the competition April 4th with a working robot.
 Each team will consist of a 3 student minimum with at least two of the team
participants attending the competition. No more than 8 per team.
 Students are required to follow Xtreme BOTS technical guidelines, including safety
inspections (inspection held on Friday, April 3rd- details forthcoming).
 Teams will provide technical documentation of the building process
 Each team will submit a $50 entrance fee no later than Friday, March 6th
Team Registration Form
School/ Organization: ___________________________________________________________
Total # of teams _______________________________________________________________
Team Name(s): ________________________________________________________________
Team Name(s): ________________________________________________________________
Team Name(s): ________________________________________________________________
Team Name(s): ________________________________________________________________
If organization/school has more than four teams, please list and attach team participant names on
separate paper.
Contact Name: _________________________________________________________________
Phone: _____________________ Email: ____________________________________________
Technical Advisor Company: _____________________________________________________
Company Team Advisor: ____________________Email: _______________________________
If school/ organization teams have multiple technical mentor/advisor companies,
please attach a complete list of them, with advisor e-mail addresses and team(s) associated with
advisor companies.
Entrance fee: $50 x teams = $ _______________
enclosed
card payment*
invoice - P.O. #
Credit Card # (Visa/MasterCard) ___________________________ Exp. date _______________
Payable to: Ohio Robotics Inc. dba Xtreme BOTS
Mail to-
XTREME BOTS COMPETITION
c/o Dysinger, Inc.
Mr. Dan Griffith
4316 Webster Street
Dayton, OH 45414
More Questions?
We’re here to help. Please contact Rebecca Cantrell, Executive Director at (937) 825-5554 or
e-mail us at [email protected]
* For personal security, Please DO NOT e-mail credit card information
Team Details
Instructions: This form must be filled out for each team. Everyone (students and adult advisors) who participates on the
team should be listed on the form.
Team Name:
Robot Name:
School/Organization Name:
City:
School/Org Emergency Contact Name (other than coach):
School/Org Emergency Contact Phone (other than coach):
Coach/Teacher - Primary Adult Supervisor:
Secondary Adult Supervisor:
Technical Advisor Company:
Company Advisor (Individuals):
Team Member Names:
1.
5.
2.
6.
3.
7.
4.
8.
Safety inspections will be held at 20-minute intervals from 12 - 4:40 p.m. on the afternoon before the competition
(Friday, 11/21 at Wright State University Nutter Center Arena). Please request an inspection time for this robot from
the times below:
□ 12:00
□ 1:00
□ 2:00
□ 3:00
□ 4:00
□ 12:20
□ 1:20
□ 2:20
□ 3:20
□ 4:20
□ 12:40
□ 1:40
□ 2:40
□ 3:40
□ 4:40
The following adult supervisor will attend safety inspections for this robot:
The following student(s) will attend safety inspections for this robot:
The following information will be used by the competition announcer – make it fun!
Robot Description:
Team Description:
Team Strategy Description/Motto:
Complete and e-mail this form
as an attachment to [email protected]
Entries must be received by Friday, March 6th
OR
Open to the first 64 teams
Questions? Contact Rebecca Cantrell at (937) 825-5554
Xtreme BOTS T-Shirt Order Form
School/ Organization: ___________________________________________________________
Contact Name: ________________________________________________________________
Contact Phone Number: _______________________________________________
enclosed
card payment*
invoice - P.O. #__________
Credit Card # (Visa/MasterCard) ___________________________ Exp. date _______________
Payable to: Ohio Robotics Inc. dba Xtreme BOTS
Mail to-
XTREME BOTS COMPETITION
c/o Dysinger, Inc.
Mr. Dan Griffith
4316 Webster Street
Dayton, OH 45414
* Please DO NOT e-mail credit card Information. Contact Rebecca at (937) 825-5554.
Short Sleeve T-Shirt: $13
Total shirt QTY: ________
Please Circle Preference (Adult sizes only)
Black
S_____
M ____ L____ XL___ 2XL_____ 3XL_______
colors other than black, must secure 12 order minimum
(Color)___________
S_____ M ____ L____ XL___ 2XL_____ 3XL_______