Excel Youth Academy Camp REGISTRATION - October 28th, 2023

Thank you for your interest in our upcoming workshop! We ask that a parent/guardian complete the registration for the student.

The student registered for the workshop must be Kindergarten - 12th grade.

Parents are not required to stay on-site during the workshop.  
1.Student's Last Name(Required.)
2.Student's First Name
3.Student's Email Address
4.Student's Phone Number - Cell is Preferred.
5.What school does the student attend?(Required.)
6.What is the grade level of the student?(Required.)
7.Student's YEAR of birth(Required.)
8.Student's Gender(Required.)
9.Student's Ethnicity/Race(Required.)
10.Student's County of Residence(Required.)
11.Student's ZIP Code of Residence(Required.)
12.Parent's Last Name(Required.)
13.Parent's First Name(Required.)
14.Parent's Email Address(Required.)
15.Parent's Phone Number - cell number is preferred.  This number needs to be the same phone number that Inspiredu can have on file as the emergency contact number for the day of the workshop.(Required.)
16.How many children (ages 0-17) live in your household?(Required.)
17.How many adults live in your household?(Required.)
18.What language is spoken most often in your home?(Required.)
19.How many computers (desktop, laptop, or tablet)  are in your home?  Please include both those you own and those that may be on loan to you from a school and/or organization.(Required.)
20.Of the computers in your home, how many do you/your family own?(Required.)
21.What type of Internet access do you have at home?(Required.)
22.What is the highest level of formal education completed by a parent/guardian in the home?(Required.)
23.Annual Household Income(Required.)
24.Our goal is for all learners to be comfortable when attending our workshops. Does your child have any needs that we may be able to accommodate? (Example – mobility, vision, hearing, etc)