2020 Application Form - Joey Travolta Summer Inclusion Film Camp
 Please complete one form per applicant.
 Pay your deposit via PayPal: http://futures-explored.org/film_camp_payment_options.html.
Email address *
Applicant Name *
Your answer
Date of Birth *
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DD
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YYYY
Age *
Your answer
Gender *
Preferred Pronouns *
Your answer
School *
Your answer
Grade *
Your answer
Home Address *
Your answer
Camper Email Address *
Your answer
Parent/Guardian 1 Name *
Your answer
Parent/Guardian 1 email *
Your answer
Parent/Guardian 1 phone *
Your answer
Parent/Guardian 2 Name
Your answer
Parent/Guardian 2 email
Your answer
Parent/Guardian 2 phone
Your answer
Regional Center Name (i.e. Regional Center of the East Bay.) If you are a private pay client please indicate N/A *
Your answer
Regional Center case manager name
Your answer
Regional Center case manager phone number
Your answer
Regional Center case manager email
Your answer
Are you interested in carpooling and sharing your contact information with other families interested in carpooling? *
City from where you would be carpooling
Your answer
Camper t-shirt size (adult sizes)
Does your camper have a 1:1 aide while at school or other activities? *
Why is the prospective camper interested in this camp? *
Your answer
Does the prospective camper require any supports/accommodations to be successful in camp? *
Your answer
What element of filmmaking most interests the prospective camper? (acting, directing, art, camera, sound, editing) *
Your answer
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