CREATE A LOOP Summer Session Registration Applicants Name * First Name Last Name Applicant's Birthdate * MM DD YYYY School * Grade * Select One 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Gender (optional) Select One Male Female Other Desired Session * Select a Session Summer Session Week 1 - July 8th through July 12th Summer Session Week 2 - July 15th through July 19th Summer Session Week 3 - July 22nd through July 26th Desired Course(s) * i-PAD PROGRAMMING WITH SWIFT INTRO TO PYTHON & MINECRAFT MODDING ROBLOX STUDIO & LUA PROGRAMMING A-FRAME VIRTUAL REALITY WEB DESIGN & DEVELOPMENT MUSIC & SOUND ENGINEERING Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent/Guardian Name * First Name Last Name Parent/Guardian Number * (###) ### #### Email Address * Please list any allergies or medical conditions. * Please note any social, emotional, or academic information we should know. * Are you applying for a scholarship? * Yes No Partial If you are applying for a scholarship, please include your household income. THANK YOU!You will receive an email from Create a Loop with further information including payment options, potential scholarship opportunities, times, location, and more.
