Coding in Scratch Registration Form
This form will register your child for Scratch coding classes at Palama! This program is for keiki ages 8 and up!

Please fill out one form for each child!

Tuesdays from 3 – 5 p.m. (16 classes)
(Aug 24, 31; Sept 7, 14, 21, 28; Oct 5, 19, 26; Nov 2, 9, 16, 23, 30; Dec 7, 14)
No class on Oct 12 (Fall Break).
Email *
Participant Information
This section will ask you information about the child you're signing up!
Participant's First Name *
Participant's Last Name *
Participant's Age *
Participant's Gender *
Participant's Grade *
Participant's Birthday *
MM
/
DD
/
YYYY
Home Phone Number *
Address *
Zip Code *
School name *
Does the participant have any medical conditions that we should be aware of? (ie. Asthma, Diabetes, seizures, heart problems, food allergy, drug allergies etc) *
Required
If yes, please provide information, and list any medications being taken.
Physician Name *
Physician Phone Number *
Medical Insurance Carrier *
Policy/Membership Number *
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