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Digital Media Summer Camp 2023 Registration
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* Indicates required question
Parent / Guardian Email Address
*
Your answer
Student Last Name
*
Your answer
Student First Name
*
Your answer
Age
*
Your answer
Grade - 2023/2024 School Year
*
5
6
7
8
9
10
11
12
Student Cell Phone Number
Your answer
School of Attendance - 2023/2024 School Year
*
Conger
Mills
Pelican
Roosevelt
Ponderosa
Klamath Home Learning Academy
Klamath Union
Klamath Learning Center
Eagle Ridge
County Elementary School
County Middle School
County High School
Ethnicity (choose one)
*
Hispanic / Latino
Non-Hispanic / Latino
Race - Please select all that apply
*
American Indian / Alaskan Native
Asian
Black / African American
Native Hawiian / Other Pacific Islander
White
Required
Parent / Guardian # 1 Last Name
*
Your answer
Parent / Guardian # 1 First Name
*
Your answer
Parent / Guardian # 1 Phone Number
*
Your answer
Parent Guardian # 2 Last Name
Your answer
Parent Guardian # 2 First Name
Your answer
Parent / Guardian # 2 Phone Number
Your answer
Street Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
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