Participant Application for the Medfield TV Youth Media Program: Film Production through Stop Motion
Thank you for your interest in the Medfield TV Youth Media Program taking place from June 24 - 27, 2024! We can't wait to read your application!

THE DEADLINE TO APPLY FOR THIS PROGRAM IS THURSDAY, JUNE 20 at 11:59pm.

This program is brought to you by Medfield TV with support from Medfield Outreach.

Soon after we receive your application, program staff will reach out to your parent/guardian with additional information, a Google form, and other required forms.

If you or your parent/guardian have any questions about this program or the application, please reach out to Katie Duval, Executive Director of Medfield TV, at katie@medfield.tv or by calling (508) 359-8888.

PLEASE NOTE: In order for your registration to be considered complete, you must:
  • Fill out this Google form.
  • Your parent/guardian must fill out the Google form that will be emailed to them.
  • Your parent/guardian must sign and return the required Medfield TV forms to katie@medfield.tv
*Scholarships are available to cover the cost of the program. This information will be included in the parent/guardian Google form.
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What is your name? *
First and last name
What name do you prefer to be called?
 *
Do you have a nickname? May be the same as above.
(e.g., Maddy instead of Madeliene)
What are your preferred pronouns? *
How would you like to be referred to? (e.g., she/her, he/him, they/them, etc.)
What is your email address? *
This email address will be used by program staff for communication related to this program only.
What is your birthday? *
MM
/
DD
/
YYYY
Do you live in Medfield? *
What grade are you in? *
Which school do you go to? *
Will you be able to attend every session and arrive on-time?
 *
Program sessions take place at the MedfieldTV studio from 1:00pm - 4:00pm on Juen 24 - 27, 2024.
What interests you about participating in this program?  *
What is your parent's/guardian's name(s)? *
What is your parent's/guardian's email address(es)? *
What is your parent's/guardian's phone number(s)? *
How did you hear about this program? *
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