Mini App Developer Workshop Registration

Student registration

Please provide the key parent, student, emergency, and consent details needed for an online workshop.

Parent / guardian

Parent / Guardian Name

Parent Email

Parent Phone

Relationship to Child

Student

Child Full Name

Child Age

Grade

Tech Experience

Workshop preferences

Workshop Format

Preferred Week

Preferred Time Slot

Device / Internet

App Idea or Interests

Safety and support

Emergency Contact

Emergency Phone

Allergies / Medical / Accessibility Notes

Anything Else We Should Know?

Waiver and acknowledgement

Parent / guardian waiver I understand this is an online educational workshop. I confirm that I am responsible for my child's physical environment, internet access, and supervision needs during the session. I understand Jarvis Institute will provide instruction, guidance, and reasonable technical support, but is not responsible for issues outside its control, including home internet interruptions, device failures, or the child's offline environment. I give permission for my child to participate in the online workshop and agree that Jarvis Institute may contact me about this registration, payment, scheduling, and workshop support.

Parent Signature Name

Date

Submitting this registration checks the selected slot. If space is available, your spot is reserved and you will continue to payment. If the slot is full, you will be redirected to the waitlist.