Immersion Application 2019
Session is limited to 10 students per week and will be filled on a first-­come-­first-­serve basis.
Which week will you attend? *
Required
Student's Name *
Your answer
Age *
Your answer
Parent/Guardian's Name *
Your answer
Email address *
Your answer
Home Address *
Your answer
Emergency Contact & Phone Number *
Your answer
Does your child have any allergies, illness, disability or other medical condition? *
If yes, please explain below
Required
Your answer
Please list any known scheduling conflicts for the duration of the session:
Your answer
Why do you want to participate with Immersion?
Your answer
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