Media Lab Enrollment Form - Collaborative School of the Arts

Media Lab after-school program is designed for middle school students interested in exploring and developing their media skills through hands-on learning.

Open to all school students in any Schenectady middle school.

Student's Name*
First Last
Parent's Name*
First Last
School Name*
Grade Level*
Date of Birth:*
MM slash DD slash YYYY
Age*
Pronoun preference*
- He/him
- She/her
- They/Them
- Other
What are your preferred pronouns?
Adult t-shirt size*
Address*
Street Address Address Line 2 City State ZIP Code
Parent's Email*
Parent's Phone*
Student's Email
Student's Phone
Emergency Contact*
First Last
Emergency Contact's Phone*
Medical Information