MX OpenTech 3.0 High School Camp Registry - STUDENT INFORMATION FORM
**If there are siblings, a separate form entry is required for each.**
Engineering and Technology Winter Camps 2017-18 for High School Students
Camp Session # *
Select the session # for Irvine and Los Alamitos Labs. Camp fee varies according to location and week. Fee is displayed in the shopping cart.
Required
Camp Location *
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
Phone
Your answer
Payment Status *
Address City *
Enter the name of the City (Street Address Not Required)
Your answer
Address Zip *
Your answer
Health Concerns *
Health Concerns, Medications, and Special Educational Needs if any. If nothing to report enter "None"
Your answer
Other Comments
Enter any info regarding prior coding, game development, App development, experience in STEM, and DIY/projects done, Siblings, Grouping Preferences, Drop-off/Pick-up by a designated person, etc.
Your answer
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