Individual Registration

Please enter information in the form below to process registration for event Coding Camp.

The Child's First Name *

The Child Last Name *

The Parent 1 First Name *

The Parent 1 Last Name *

The Parent 2 First Name

The Parent 2 Last Name

Address *

City *

Zip *

State *

Phone 1 *

Phone 2

Email 1 *

Email 2

Wechat Name *

Wechat ID *

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Phone *

Grade In Sep *

Age *

Weeks *

Week1(7/6 to 7/10)

Week2(7/13 to 7/17)

Week3(7/20 to 7/24)

Week4(7/27 to 7/31)

Week5(8/3 to 8/7)

Week6(8/10 to 8/14)

Lunch($75 per week) *

Yes

No

Bus($185 per week) *

Yes

No

Coding *

Python Basic

Python with AI

Java Basic

Java with USACO

C++

Food Allergy *

Yes

No

Food Allergy Details

Comment

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