TechCORE2, Fall 2017 | Coding + Robotics Sign Up
{UPDATED 09/23/2017}

CODING WORKSHOPS (Most Classes, No Experience Necessary)
A) Parent & Me: Intro SCRATCH Coding* (for students grades K - 2nd) / Fall 2017
B) Young Coders: Intro SCRATCH Coding (grades 3rd to 5th) - Fall 2017 - [***CLOSED***]
C) Mid Level Coders: Intro to SCRATCH Coding (grades 6th to 8th) - Fall 2017 - [*** Only 2 SLOTS LEFT***]
D) Intermediate* SCRATCH Coding w/ Robotics (grades 1st to 8th) Fall 2017
E) Engineering -w- LittleBits / Fall 2017 (grades 3th to 5th)
F) WordPress Web Development (grades 7th to 12th) Fall 2017

TIME SLOTS: classes A, B, and C (11:00 am - 12:30 pm) | classes D, E, and F (1:00 pm - 2:30 pm)

- $125 for (8) Saturdays starting September 30, 2017, ending November 18, 2017 (includes T-shirt)
- $100 for past participants; new participants Paid-In-Full by 8/31/2017
- PAYMENT PLAN: We will accept partial payments up through Friday 9/16/2017. Contact if you need additional assistance.
Your Sign Up will be Confirmed once payment is received.

1) PayPal.Me
2) Paypal "Friends & Family" via
3) Google Wallet to
4) Check payable to Mercy-Douglass Corporation
5) Cash
6) Fundraiser Program

PARENT / GUARDIAN Video & Picture Release Form ( Please download, complete and sign and e-mail to or bring in for 1st day of the program.

TechCORE2 is a non-profit program sponsored by the strategic alliance of Mercy-Douglass Corporation (, a 501c3 Tax Exempt health & human services organization, and JCW Computer Consulting, LLC (, a Philadelphia based technology firm.

Website: |

Email address *
TechCORE2 Coding, Fall 2016 Young Coders Interview
Parent / Guardian Name *
Your answer
Address *
Your answer
Address 2
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Cell *
Your answer
Alternate Phone
Your answer
Are you interested in the TC2 fundraising opportunities to assist with registration or computer purchase? *
Student Name(s) (please enter up to 4 students, 1 name per line) *
Your answer
Student Grades (up to 4 students) *
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Student 1 (cannot not be N/A)
Student 2
Student 3
Student 4
Student T-Shirt Size *
Child S
Child M
Child L
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Student 1 (cannot be N/A)
Student 2
Student 3
Student 4
Student 1 Class *
Student 2 Class
Student 3 Class
Student 4 Class
How did you learn about our program?
Comments or Suggestions
Your answer
Joel Interviewing of MESA Middle School Students who worked with LittleBits Student Sets during Summer 2017 engineering camp
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Never submit passwords through Google Forms.
This form was created inside of Mercy Douglass Human Services Affiliate. Report Abuse - Terms of Service - Additional Terms