Summer at StoryArk 2023 Registration

1

Student Name* This field is required.

First Name

Last Name

2

Your mailing address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

3

Student date of birth* This field is required.

Date

4

Student Gender* This field is required.

Male

Female

Non-Binary

Prefer not to say

5

Student Email * This field is required.

example@example.com

6

Student phone number

Please enter a valid phone number.

7

Are you able to receive texts? * This field is required.

YESNO

8

Current Grade* This field is required.

9

Which region are you from?* This field is required.

East Metro Twin Cities

South Central MN

11

If your district is not listed, please list it here.TC Districts

12

Your School District* This field is required.South Central Districts

Hastings

St. Peter

Mankato Area Public Schools

Other

13

If your district is not listed, please list it here.South Central Districts

14

Your School* This field is required.TC Schools

15

If your school is not listed, please list it here.TC Schools

16

Your School* This field is required.South Central Schools

17

If your school is not listed, please list it here.South Central Schools

18

What medium are you most interested in exploring?* This field is required.Choose two that apply, and note that this is a 3 week storytelling camp where you will choose to dive into podcast, film, creative writing, and music

Podcast

Film/Animation

Music

Creative Writing

19

This is an in-person camp, however, we are able to make accommodations for those who need to join online. How would you prefer to join camp?* This field is required.

In-person

Online/Zoom

20

Race/Ethnicity/Communities* This field is required.This information and language 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.

21

Disability/Different Ability?If applicable.

22

AccommodationsStoryArk is committed to providing access to all of our programing. If you have a disability and may require accommodations to participate, please indicate that here.

23

Dietary Needs, Restrictions, or AllergiesPut "None" if not applicable

24

Why do you want to participate? * This field is required.

25

What do you hope to learn? What are you looking forward to?* This field is required.

26

Anything we should know?

27

Parent/Guardian Name* This field is required.

First Name

Last Name

28

Parent/Guardian Email* This field is required.

example@example.com

29

Parent/Guardian Phone Number* This field is required.

Please enter a valid phone number.

30

Parent/Guardian SignatureI authorize my student, named above to participate in StoryArk's programming. I release StoryArk of all liability of injury, death, or other damages to me, my child, or family that may result from his/her participation in the program, including but not limited to transportation, and hold harmless any StoryArk program staff, volunteer, or other representatives, both collectively and individually, of any injury, physical or emotional, other than where gross negligence has been determined. I give permission to StoryArk staff, volunteers or other representatives to seek medical attention for my child if needed during the course of their participation in the program. I give permission for my child to utilize various technologies and access to the internet for educational purposes.

Clear

31

Marketing and Promotions* This field is required.I give permission for photos or video recordings and partial or complete quotes of my child to be reproduced for promotional and educational purposes and/or related events. (Please note, your child's personal information, including name, school, etc will be used)

I DO give permission for photos or video recordings and partial or complete quotes of my childto be reproduced for promotional and educational purposes and/or related events.

I DO NOT give permission for photos or video recordings and partial or complete quotes of my child to be reproduced for promotional and educational purposes and/or related events.

32

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.

Clear