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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