Nubian Directions II, Inc.
giuseppe@nubiandirections.org
www.nubiandirections.org
(845)-452-8574
Summer Innovation Lab
AGES 16 TO 19 ONLY | DATES ARE FROM JULY 1ST TO AUGUST 16TH
Basic Information
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Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
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Nepal
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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
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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
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Singapore
Slovakia
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Solomon Islands
Somalia
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Spain
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Sudan
Suriname
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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
United States
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
Emergency Contact
First Name
Last Name
Relationship
ex. Father, Mother, etc.
Address Of Person To Contact In Case Of Emergency
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
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
United States
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
Phone Number Of Person To Contact In Case Of Emergency
Please enter a valid phone number.
Email Of Person To Contact In Case Of Emergency
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Academic Background
High School Name
Extra Curricular Participation
Student Council
Class Officer
Club/Organization
Varsity Player
Sports
Honors Society
Other
Other Details
What is your T-Shirt size?
XS
S
M
L
XL
XXL
XXXL
What is your ethnicity?
Black or African American
Hispanic or Latino
American Indian or Alaskan Native
Asian
Native Hawaiian or other Pacific islander
White
Two or more Mixed races.
Resources Available
Car/Transportation
Printer
Laptop
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Which of the following are you interested in?
Drones
Laser Engraving
Coding
Aviation
E-Sports
Video Arcade
Podcasting
Photography
Sewing / Embroidery
Videography
Programming
Other
Favorite Subject
Math
Science
Social Studies
English
Other
Which of the following recreational activities do you enjoy?
Basketball
Bowling
Chess
Frisbee
Scrabble
Soccer
Softball
Swimming
Table Tennis
Track and Field
Tennis
Volleyball
Fishing
Bicycling
Camping
Other
Any health concerns, allergies, or illnesses, or accommodations that we should know about?
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Tell Us A Little Bit About Yourself
Do You Plan To Go To College?
Yes
No
Suggestions / Comments
How did you hear about the program?
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CONTACT CONSENT: I consent to be contacted by Nubian Directions II, Inc. via phone, email, or any applicable method regarding this program.
*
I provide consent to be contacted.
NAME/PHOTOGRAPH RELEASE: Press organizations and Nubian Directions II, Inc. may do stories on the Summer Innovation Lab Workshops and/or activities and benefit the youth by showcasing their achievements. Please indicate whether or not you want your name or photograph to be released to the press.
*
I DO provide consent.
I DO NOT provide.
DISCLAIMER: This camp is not regulated or inspected by the New York State Department of Health and is not required to obtain a Department of Health permit. This camp is not required to follow Department of Health regulations, including, maintaining minimum staff-to-child ratios; hiring medical personnel; or reporting injuries or illnesses to the Department of Health.
I have read and acknowledge this statement.
PARTICIPANT AGREEMENT: I agree to be an active participant in Summer Innovation Lab Workshops for the 2024 program. I will attend the activities and actively participate in project work. I will respect the presenters and the other participants in the program. I agree to attend all sessions or let program staff know in advance of a conflict. Sign name below.
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