Middle School Girls Cybersecurity Camp 2021 Registration Form

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Please complete this form in its entirety to be considered for the Summer 2020 Cybersecurity camp. Please note that if the camp is fully subscribed, then any additional applications will be held on wait list.

Full Name: *

Age *

School attending in Fall 2020 *

Grade in Fall 2020 *

Home Address *

Parent/ Guardian Name *

Parent/ Guardian Phone Number *

Parent/ Guardian Email *

What is your typical t-shirt size? *

XXL

Emergency Contact Name (if different than above)

Emergency Contact Phone Number (if different than above)

Emergency Contact Email (if different than above)

Race/ Ethnicity

Do you have any dietary restrictions? *

Yes

If you said "Yes" above, please specify your allergies below:

Please list any ADA or other medical accommodations needed:

Why are you interested in cybersecurity/ this program? *

What are your hobbies or interests? *

What do you hope to get out of this program? *

Do you have any previous coding or computer programming experience? *

Yes

If you said "Yes" above, please list this experience:

Submit

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