Teen Programming Academy - December 2017 Class Registration
Child's Name *
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Parents Name *
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Which class are you registering for? (Select One) *
Address
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City *
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Parent Home Phone Number *
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Parent Cell Phone
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Parent Email *
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Child's Grade level 2016 - 2017
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Child's Age *
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Child's School *
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School PTO / PTA
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Child will need a laptop with Windows OS. Do you have one or need to borrow one during class? *
Prior Programming Experience
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Additional Comments
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Payment Method *
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