Computer Genesis™ Application ( Enrollment)

Select Session

Session 1: Monday & Wednesday Evenings 5:30PM - 8:00PM
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Session 2: Tuesday & Thursday Evenings 5:30PM - 8:00PM

Requested Session: Session 1 or Session 2

Parent/Legal Guardian General Information

First Name: Last Name:

Street: City: Zip:

Emergency Phone: Email:

Own a Computer: Yes No

Computer Type: PC Mac

Student General Information

First Name: Last Name:

Age: Grade: School:

Describe Student's Experience With Computers (Courses Taken, etc.):

Student Medical Information

Allergies: | Asthma: | Other (Specify):

Additional Comments and/or Concerns:

By clicking Submit you are providing consent for your child/ward to attend BAYM's Computer Genesis™ program. You also grant BAYM permission to seek and obtain medical treatment for your child/ward if so needed.