Writers at Harriman Application Form
Student Registration Form
Email *
Cannot pre-fill email
Instructions
Skip over the first line above (email). If you do not get a response in 24 hours, copy answers and email them to writersatharriman@gmail.com. 
Date of application
MM
/
DD
/
YYYY
Type of application *
For scholarship applicants, will you still be interested if you only receive a partial scholarship?
Tell us a little about yourself and why you're interested in this camp. *
Your answer
Student's first name *
Your answer
Nick name if preferred
Your answer
Student's last name *
Your answer
Street address *
Your answer
Town, State, and zip code *
Your answer
Parent or Guardian's name *
Your answer
Parent or Guardian's telephone number *
Your answer
Student's telephone number *
Your answer
Parent or Guardian's email address *
Your answer
Student's email address *
Your answer
Student Pronoun preference *
Does the student have allergies or food concerns we should be aware of? If so, please describe those needs below.
Your answer
Does the student have any emotional, mental, or physical impairment that would require a parent, guardian, or healthcare professional to accompany them during camp? If so, please contact the camp Director, Sherry Briscoe at sherryabriscoe@gmail.com.
Your answer
Name of School *
Your answer
Entering grade *
Teacher who knows the student well *
Your answer
Teacher's email address *
Your answer
What does the student like to read? *
Your answer
T-Shirt size *
How did you hear about Writers at Harriman?
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