Summer Camp 2017 Registry - STUDENT INFORMATION FORM
**If there are siblings, a separate form entry is required for each**
**A separate entry for each week per camper**
Mathobotix OpenTechLabs
Camp Session # *
Please select one. Please note Codologie and Gamologie camps are available to 3rd grade and above. Please note there are 2 levels of Gamologie camps available. Camp fee varies based on camp types. July 4th short camp week has reduced fee.
Camp Location *
Camp Type (Learning Platform/Time Format) *
Buildologie, Codologie, Gamologie, Etc
Student Grade *
Student First Name *
Your answer
Student Last Name *
Your answer
Student Gender *
Mother/Guardian First Name *
Your answer
Mother/Guardian Last Name *
Your answer
Father/Guardian First Name *
Your answer
Father/Guardian Last Name *
Your answer
Contact eMail *
Valid eMail ID required
Your answer
Preferred Phone *
Preferred Phone
Your answer
Alternate Phone
Your answer
Payment Status *
City *
Enter the name of the City (Street Address Not Required)
Your answer
Zip *
Your answer
Health Concerns *
Health Concerns, Medications, and Special Educational Needs if any. If nothing to report enter "None"
Your answer
Relevant prior Mathobotix Buildologie/Codologie/Gamologie or other robotic/programming experience
Enter any other comments, prior Mathobotix Buildologie/Codologie/Gamologie or other robotic/programming Experience, and any info regarding Siblings, Grouping Preferences, Drop-off/Pick-up by a designated person, etc.
Your answer
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