SOAD Summer Design Academy Application

STUDENT INFORMATION

First Name

Last Name

Birthdate

Email Address

Mobile Phone

Do you agree to receive text messages from New York Tech?

Yes

No

Home Address

Country

Street

City

Region

Postal Code

PARENT INFORMATION

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone

EMERGENCY CONTACT

Emergency Contact Full Name

Emergency Contact Relationship to Child

Emergency Contact Phone Number

ADDITIONAL INFORMATION

In 2025, what grade will your child be entering?

Most Recent School Attended (Choose Unknown or Unlisted School, if not found)

This program runs Monday through Friday, 10 a.m. to 4 p.m., from July 8 through July 25. Check the box to confirm your child can attend five days per week for the whole session.

Yes, my child can attend the full session.

No, there are some days that my child will need to miss.

Please mark all of the following your child has experience with. (Experience is not required for program participation, we are just curious.)

If the program is full, are you interested in your child being put on a waiting list?

Yes

No

Any dietary restrictions or special accommodations?

Note: You must also complete and return these forms by the required due date.