* 1. Please enter your first and last name.

* 2. Please enter your mailing address and phone number.

* 3. Please enter an emergency contact name and phone number.

* 4. What school do you attend?

* 5. What t-shirt size do you prefer?

* 6. Please list any dietary restrictions below.

* 7. Where did you hear about Code Camp?

* 8. Please indicate how much experience you've had with the following:
(1 = none, 5 = proficient)

  1 2 3 4 5
HTML
Ruby
CSS
iPro
Scratch

* 9. Will you be bringing a laptop, iPad, and/or another device with you?

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