Jayhawk Media Workshop - Registration

What workshop are you registering for?

Student first name

Student last name

Student cell phone number while on campus

Street address

City

State

Zip code

Student email

Gender

2022-2023 grade

Emergency contact name

Emergency contact relationship to student

Emergency contact email

Emergency contact phone number

School name

School street address

School city

School state

School zip code

Journalism teacher / publication adviser's name (if applicable)

Adviser's email (if applicable)

Your position on your publications staff for 2022-2023 (if applicable)

FIRST CHOICE: Please enroll me in . . .

SECOND CHOICE: Please enroll me in . . .

Roommate preference #1 (if none, leave blank)

Roommate preference #2 (if none, leave blank)

Dietary needs for camper

Adult t-shirt size

Method of payment

I give permission for the Jayhawk Media Workshop to use images of me created during camp in camp newsletters, web posts and publicity materials for the camp.

If you have a disability and require accommodations to participate in the Jayhawk Media Workshop, please check here. We will be in touch to make arrangements.

How did you hear about the Jayhawk Media Workshop?