Camp NetWorx! Camper Signup Part One This is the first part of three in signing up for Camp Networx! What is your email?(Required) Is this your email address? Yes No How often do you check your email? Every day Every other day About once a week About once a month You will need to be at all live camp events. We want you and all the campers to benefit from each other. Your mentor will work with you outside of live camp events to make sure that you can do all camp activities and be a part of each live camp event. Check your calendar and make sure that you are able to attend the following camp events. I can be at all the camp events.(Required) Yes No Contact InformationWhat is your name?(Required) First Last How old are you?(Required) What is your phone number?(Required)If you have a cell phone, put that number here. If you do not have a cell phone, give your parent's cell phone or your home phone number.Is the number you provided your cell phone number? Yes No What is your mailing address?(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Getting to Know YouWhere were you born?Where do you live?What is one word that describes you? Tells us about yourself.What is one thing that makes you unique?DemographicsThe questions in this part of the form are optional; you do not have to answer them if you do not want to. Your answers will be used by the CTA and PMW to support you in your camp activities. All camper's answers may be used to make a Camp NetWorx demographic profile. All your answers will be the property of CTA and PMW and will only be shared with your consent. What are your preferred pronoun? She/her He/him They/them Other Please share about your disability or disabilities?Please share your racial or ethnic identity. White (e.g., Caucasian, European, Irish, Italian, Arab, Middle Eastern) Black or African-American (e.g., Negro, Kenyan, Nigerian, Haitian) Asian or Asian-American (e.g., Asian Indian, Chinese, Filipino, Vietnamese or other Asian origin groups) Native American/American Indian/Alaska Native Pacific Islander/Native Hawaiian Hispanic/Latinx (e.g., Mexican, Puerto Rican, Cuban) Multi-racial (non-specified) Other Activities and InterestsShare with the project team some information about your current activities. We are here to support you and the information you provide to the following questions will help us customize and support your camp experience. What is your grade level in school? Yes No What is your school grade level? High school (9th-12th Grades) Trade school College or university I am not in school Other What is your job, career, or employment goal? Please share any career or employment goal that you would like to meet?What do you like to do for fun?Do you have a job? Yes No I do not have a job, but I am a volunteer or an intern. I do not have a job, but I have work experience. Other What social media platforms do you use? Facebook Twitter Snapchat YouTube Instagram TikTok Mark all that you have and that you use.We will be using Zoom for this virtual camp. Have you ever used Zoom? Yes, I use Zoom. Yes, I have used Zoom some. No, but I have heard of Zoom. No, I have never heard of Zoom, but I look forward to using a new tool. No, I have never heard of Zoom. I would like to have help to use this tool. To be a part of this virtual camp on Zoom, do you need any accommodations? Yes No If you need help sharing your accommodations, talk with your mentor. Example: sign language interpreter or C.A.R.T. captioning.In between the times that we meet on Zoom, we will be using a “chat” app called Slack. Your mentor will help you to set up and use this new app. Have you ever used slack? Yes, I use Slack. Yes, I have used Slack some. No, but I have heard of Slack. No, I have never heard of Slack but I look forward to learning a new tool. No, I have never used Slack and I would like to have help to use this tool. Please share anything that Peer MentoringWorks and your mentor should know to help you have the best time at camp. Add anything that you would like to share about yourself. Camp NetWorx is a camp for all abilities. We want to help all campers, like you, to make camp fun. We know that not everyone wants to share about their disability or needs but we want to make a safe place that lets you share about yourself when you are ready. What happens in camp, stays in camp!
