ESSK V-Camp Camper Intake Form Please fill out the form below Parent Name* First Email* Phone*Camper Name* First Camper AgeCamper Age* 6 7 8 9 10 11 Email to be used for V-Camp Class* Name of InstructorName of Instructor* Taylor Jasmine Laure Are you registered for a one-week or two-week program?Program* One-Week Two-Week What session are you registered for?One-Week ProgramAugust 3rd – 7th, 9am-12pm EDTAugust 3rd – 7th, 1pm-4pm EDTAugust 17th – 21st, 9am-12pm EDTAugust 17th – 21st, 1pm-4pm EDTSessionAugust 3rd – 7th, 3-4:30pm EDTAugust 10th-14th, 3pm-4:30pm EDTTwo-Week ProgramAugust 3rd – 14th, 9am-12pm EDTAugust 3rd – 14th, 1pm-4pm EDTAugust 17th – 28th, 9am-12pm EDTAugust 17th – 28th, 1pm-4pm EDTI am aware that all classes are Eastern Standard TimeI am aware that all classes are Eastern Standard Time* Yes No If you have chosen your class time in error, please indicate in the comments field below and we will assist you. Can your child read independently?Can your child read independently?* Yes No If your child is not able to read independently, you will need to have someone with your child during each class in order to assist. Does your computer meet the necessary requirements for this program?Does your computer meet the necessary requirements for this program?* Yes No You must have a Chromebook or utilize Google Chrome Browser as well as Zoom installed in order to participate in the ESSK V-Camp program. Does your child have any experience with coding and programming?Does your child have any experience with coding and programming? If yes, explain.* Yes No Please tell us more about your child's previous coding experience.*Does your child have a quiet place to work while they are in each session?Does your child have a quiet place to work while they are in each session? Yes No A quiet spot where your child is able to concentrate and engage is required for a successful ESSK V-Camp experience!What are you hoping to get out of enrolling your child in this program?*Is there anything we need to know about your child that would help us better run our session better?We love to develop our program with our campers in mind. Please describe any special interests your child may have.CommentsHow did you hear about us?How did you hear about us?* Google Search Facebook Instagram Make Wonder Friend Other Name of Friend* Other* EmailThis field is for validation purposes and should be left unchanged. Contact Tel: (888) 682-3775 Email: info@extremesteamscience.com
