MX OpenTech 3.0 High School Camp Registry - STUDENT INFORMATION FORM
**If there are siblings, a separate form entry is required for each.**
Camp Session # *
Select the session # for Irvine and Los Alamitos Labs.
Required
Camp Location *
Student Grade *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Gender *
Mother/Guardian First Name *
Your answer
Mother/Guardian Last Name *
Your answer
Father/Guardian First Name *
Your answer
Father/Guardian Last Name *
Your answer
Contact eMail *
Valid eMail ID required
Your answer
Preferred Phone *
Preferred Phone
Your answer
Alternate Phone
Phone
Your answer
Camp Fee *
Payment Status *
Address City *
Enter the name of the City (Street Address Not Required)
Your answer
Address Zip *
Your answer
Health Concerns *
Health Concerns, Medications, and Special Educational Needs if any. If nothing to report enter "None"
Your answer
Other Comments
Enter any info regarding prior coding, experience in STEM, and DIY/projects done, Siblings, Grouping Preferences, Drop-off/Pick-up by a designated person, etc.
Your answer
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