Name *

First Name

Last Name

Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have any prior coding or STEAM related experience? *

Science, Technology, Engineering, Arts or Mathmatics

Yes

No

Have you taken any coding courses? *

Yes

No

Parents Name *

First Name

Last Name

Parents Phone Number *

(###)

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