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Summer 2022 Registration
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1
Student Name
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First Name
Last Name
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2
Student Nickname (if applicable)
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3
Student Email
*
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example@example.com
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4
Student Cell
Please enter a valid phone number.
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5
Current Grade
*
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9th
10th
11th
12th
9th
10th
11th
12th
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6
If other - please indicate
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7
If other - indicate district
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8
Birth Date
*
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Month
Day
Year
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9
Which region are you from?
*
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East Metro Twin Cities
South Central MN
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10
High School TC
*
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Forest Lake Area
Hastings
Inver Grove Heights
Roseville Area
Simley
Stillwater Area
White Bear Lake Area
Other
Forest Lake Area
Hastings
Inver Grove Heights
Roseville Area
Simley
Stillwater Area
White Bear Lake Area
Other
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11
High School SCM
*
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JWP
Mankato East
Mankato West
Mankato Central
St Peter
Other
JWP
Mankato East
Mankato West
Mankato Central
St Peter
Other
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12
Your School District TC
*
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TC
Stillwater Area Public Schools
Hastings
St. Peter
Mankato Area Public Schools
Forest Lake
Inver Grove Heights
Janesville-Waldorf-Pemberton
Roseville
South St Paul
White Bear Lake
Other
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13
Your School District SCM
*
This field is required.
SCM
Stillwater Area Public Schools
Hastings
St. Peter
Mankato Area Public Schools
Forest Lake
Inver Grove Heights
Janesville-Waldorf-Pemberton
Roseville
South St Paul
White Bear Lake
Other
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14
East Metro Twin Cities
Choose the Camp/Program you wish to take part in
Podcast Camp (in person)
Creative Writing Intensive (in person)
Film Camp (virtual)
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15
South Central MN Programs/Camps
Choose the Camp/Program you wish to take part in
Storytelling Camp (in person)
Film Camp (virtual)
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16
Race/Ethnicity/Communities
*
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This information is required by our grantors. Your willingness to indicate helps us receive resources to serve students. Please note that this information will remain PRIVATE and names will never be attached to data.
Asian/Asian American
African/Black/African American
Afro-Latinx
Hispanic/Latinx/Chicanx
Middle Eastern/North African
Mixed - more than 1 race
Native America/American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
White/Non-Hispanic
Prefer not to say
Asian/Asian American
African/Black/African American
Afro-Latinx
Hispanic/Latinx/Chicanx
Middle Eastern/North African
Mixed - more than 1 race
Native America/American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
White/Non-Hispanic
Prefer not to say
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17
Disability/Different Ability?
If applicable.
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18
Your Mailing Address
*
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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19
Parent/Guardian Name
*
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First Name
Last Name
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20
Parent/Guardian Email
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example@example.com
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21
Parent/Guardian Phone Number
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Please enter a valid phone number.
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22
Why do you want to participate? How will it help you? How will it help others?
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23
Anything we should know?
Please detail anything we should know about the student that can help us create the best possible creative environment
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24
Will you need transportation?
*
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Do you need help getting to and from camp?
YES
NO
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25
Please let us know where you need to be picked up and or dropped off.
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26
Parent Signature
*
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I authorize my student, named above to participate in StoryArk's online communities through video conferencing and other remote technologies. I acknowledge that all sessions will be recorded and archived and may be used or reviewed.
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27
Intellectual property rights
*
This field is required.
In consideration for the mentoring and educational opportunities being given to me by StoryArk and in recognition of StoryArk's collaborative creative process, I give StoryArk permission to use my image and my voice in its publications, podcasts, videos, social media and in all other formats without additional compensation. I hereby assign and transfer to StoryArk all right, title and interest that I may have in materials created while working for or with StoryArk, including but not limited to: written materials, videos, audio recordings, digital recordings, images and anything else produced for StoryArk or its projects, podcasts and videos. StoryArk hereby grants me a license to use the images, audio and materials on my personal reels, portfolios and resumes. I may also reproduce and distribute the materials to my instructors, teachers, and professors to receive academic credit for the work performed. This license does not give me the right to revise, add content or otherwise create derivative works from the items listed above without express permission of StoryArk.
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28
Terms and Conditions
*
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StoryArk strictly adheres to its Codes of Conduct for both youth and adult participants. Click here to view all StoryArk Policies.
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29
Please verify that you are human
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Summer 2022 StoryArk Registration
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