Thank you for your interest in applying to be part of our FREE Code Dance Create camps!

Use this form to apply for the camp at the southern Oregon Coast, August 12-16.
It will be held at North Bay Elementary School, 193670 Viking Ln #1, North Bend, OR 97459. It is open to incoming grade 4 to grade 8 students. Advanced grade 3 students will also be considered.

    Name of Youth Applicant (required)

    Name of Parent or Guardian (required)

    Relationship to Youth Participant (required)

    Home Address (required)

    Email Address (required)

    Phone

    City, State

    Age of Applicant

    Grade in September

    Name of School in September

    Are you able to provide transportation for your youth?

    Would you need the camp to provide transportation for some or all days?

    Will the youth be able to commit to participating in the camp for all days and times of the selected week?

    Please list any dietary restrictions and/or allergies:

    Ethnicity(ies)/Culturally important information:

    Preferred method(s) of contact:

    Alternate phone number(s) (if applicable):

    The following questions are for the prospective youth participant.

    Please describe why you are interested in joining a Code Dance Create camp. What do you hope to learn and/or create?

    Do you have any experience with computer coding and/or dance? If so, please describe that experience.

    Please list anything else you would like us to know about you and/or your family.

    Please attach a photo of the youth applicant. (Optional, but encouraged and helpful for us--we will not share it.):