(Please print this form, fill out and mail with a $75.00 deposit)

Registration Form

Digital Double 3D Animation Immersion Program

In Partnership with the City of Redmond Teen Center

Mail To:

15814 Bear Creek Parkway

Redmond, WA 98052

A weeklong hands-on animation experience for middle to high school students (ages 14-19)

Which session/s are you registering for? (Please check one)

Morning (9am-1pm)	Afternoon (2pm-6pm)	Dates
		July 5-9^th
		July 12-16^th
		July 19-23^nd
		July 26-30^th
		Aug 2-6^th (advanced)

In the event that your choice is full, please list alternative sessions in order of preference:

1^st:

2^nd:

3^rd:

Student information

Name

Age

School and grade in fall

Address

Phone number(s)

Email

How did you hear about this program?

Parent/guardian information

Name(s)

Address (if different from student)

Phone number(s)

Email

Medical information

Emergency contacts (names and phone #s)

Doctor (phone # and address)

Medical insurance provider

Policy number

Dentist name

Dental insurance provider

Policy number

Dietary Restrictions/Preferences (circle one each)

Vegetarian	Yes	No
Vegan	Yes	No
Lactose intolerant	Yes	No
Allergies	Yes	No	If yes, please explain:
Other	Yes	No	If yes, please explain:

Do you have any handicaps, limiting health conditions, medications, reactions to medications or any additional medical/health information that we should know about?

Program information: Program cost ($540* total) includes 20 hours of instruction (including breaks) from professionals in the field and experienced educators; snacks and beverages; use of required hardware and software; notebook, sketchbook and writing/drawing utensils will all be provided.

Please note: this is a closed campus program. Students will not be allowed to leave the premises during program hours except with a parent or guardian without prior written parental consent. All instruction will occur at Digital Double’s studio, located at 15814 Bear Creek Parkway (2^nd floor) Redmond, WA 98052. Program is not an internship or employment, nor is it training for future employment. Program is not accredited or affiliated with any educational institution.

Refund policy: The $75 deposit is non-refundable.  The balance of $465 is due at 9am on the first day of your session, and is refundable only in extenuating circumstances (ie. serious illness or family emergency). In the event of class cancellation due to low enrollment, you will be offered the choice of attending another session, or a full refund (including deposit).

Student will be expected to make their own transportation arrangements for arriving and leaving on time.

I, __________________ (parent or guardian name) hereby agree to not hold Digital Double and its agents liable for any injuries or incidents that may occur during the course of this program. By signing, I also give Digital Double and its agents permission to call for medical transport in case of a medical emergency.

_____________________

Parent signature

_____________________

Student signature

Questions? Call (425) 867-0400 or email info@digitaldouble.net

Please send completed form and $75 deposit to:

Digital Double

15814 Bear Creek Parkway

Redmond, WA 98052

* $495.00 for Redmond Residents (Thanks to partnership with City)