Youth Program Enrollment

Complete the form below to enroll your student in a program. If you have any questions, you can email us at

techcenter@digitalharbor.org.

Participant Information

Participant First Name

Participant Last Name

Participant Email

School Name

Grade in Current School Year

Date of Birth

Gender

Race/Ethnicity

Street Address

City

State

Postal Code

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Note We will send program-related communication to this address, so please provide an email address you actively use.

Parent/Guardian Phone

Check here if you would like to add a second Parent/Guardian

Second Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Note We will send program-related communication to this address, so please provide an email address you actively use.

Parent/Guardian Phone

Program Selection

What program are you interested in enrolling in?

Note You can enroll in more than one session by clicking the link below to add another program.

Note: this form takes a few moments to process after you click submit. You will receive a confirmation message by email when we receive your submission.