Please fill out the following application. Once you click submit, you will be taken to a secure credit card processing page where you will complete the application process by paying the $400 deposit fee with any major credit card via Paypal.

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Confidential Registration Form

Parent's Name:

Parent's Email:

Parent's Cell Phone Number:

Parent's Home Phone Number:

Parent's Mailing Address:

Emergency Contact Number:

Student's Name:

Student's Age:

Current School / Occupation:

What is this student most excited about learning or experiencing during the Film Workshop?

How can we best support this student in having a fun, successful experience at the Film Workshop?

Does this student require 1:1 support in the community?
Yes No 
Please provide two professionals which we can contact to learn more about this student:

Are you seeking IEP funding for this summer program? If so, please provide the name of the contact person or approving this funding.