Tampa Entrepreneurship Summer Camp Registration

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******* Minority Students in STEM will be given preference ************

Who:
Grades 7-12

When:
July 18th-22nd
10:00 AM to 5:00 PM EST

Where:
Amgen Capability Center, Tampa, FL

Cost:
Free

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If not selected in this batch - you will be considered for a low cost program later in summer
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Full Name *

Student email (Please list your personal email - not school associated email) *

Student phone number

Home City *

Home State *

Home Zipcode *

School Name *

Grade *

Age *

Please select the response that best represents your gender identity: *

Male

Female

Non-binary/non-conforming

Other

Decine to Answer

Please select the response that best represents your racial identity *

Asian or Pacific Islander

Black or African American

Hispanic or Latino

Native American or Alaskan Native

White or Caucasian

Multiracial or Biracial

A race/ethnicity not listed here

Decline to Answer

Do you qualify for or receive free or reduced lunch at school? *

Yes

Unsure

Prefer not to answer

Parent Name *

Parent Phone Number *

Parent Email *

Please indicate your level of experience with any type of entrepreneurship - remember, no experience is needed at all! *

I have no experience with entrepreneurship.

I am very familiar with and comfortable with entrepreneurship.

Please indicate your level of experience with any type of coding /web design - remember, no experience is needed at all! *

I have no experience with entrepreneurship.

I am very familiar with and comfortable with entrepreneurship.

Have you participated in a entrepreneurship camp before? *

Yes

Have you participated in a coding / web design camp before? *

Yes

What are you hoping to learn or gain from this camp? (1 or 2 sentences) *

How did you hear about this camp? (Organization, counselor, friends, family, WhatsApp, email list, social media, etc) Mention specifcally tha name of org / friend / contact *

Liability Waiver Accepted by Parent *

By saying yes below, I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages, or which may hereafter occur to me as a result of participation in said event. This release is intended to discharge in advance Shooting Stars Foundation Inc and Amgen Inc, its officers, student and parent volunteers from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. I hereby give my consent to Shooting Stars Foundation and Amgen Inc to take photographs, video recordings, and/or sound recordings of me during my participation. I grant Shooting Stars Foundation and Amgen Inc my permission to use the negatives, prints, motion picture, video tapings, or any other reproduction of the same for promotional purposes on flyers, on the World Wide Web, or in any other manner deemed necessary. I expressly state that I have read, understand and am familiar with all provisions herein. I understand that this release is a contract and I sign it of my own free will. I agree to all terms and provisions herein.

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