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* 1. Student's Name

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* 2. Birth Date (MM/DD/YYYY)

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* 3. Student's Grade

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* 4. Student's Gender

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* 5. Address

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* 6. Parent/Guardian's Name

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* 7. Parent/Guardian's Address

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* 8. Does the student have access to a computer with internet connection?

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* 9. Informed Consent and Acknowledgement:
I hereby give my approval for my child’s participation in this virtual program. 
By clicking "Yes", I am delivering an electronic signature as an original manual paper signature. 

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