September 17 PBS Kids ScratchJr Code Camp Registration

Student Name*
First Last
What grade is student currently enrolled in?*
Parent/ Guardian Name*
First Last
Parent/ Guardian Phone*
Parent/Guardian Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
What aspects of technology interest your child? Any prior hands-on experiences or projects?*
Does your child's school teach computer science?*
How did you hear about The Div's camps?
Student's Gender*
Which of the following best represents the racial or ethnic background of the student? Select all that apply.*
Lunch will be served at camp. Does your child have any dietary restrictions we should know about?*
Camper t-shirt size?
Will you be bringing an iPad or using one provided at camp?
- My student can bring his/her own iPad
- My student will use an iPad provided by The Div
Media Release*
- I grant permission
- I do not grant permission
I give my permission for photos taken of my child at this event to be shared in printed or online materials for promotion, marketing and development by The Div. (Photos from the day will be shared on Facebook, etc.)
Camp Registration Fee
Price: $40.00
* Scholarships and multi-child family discounts are available. Email info@thediv.org for details.