Adult Tech Registration

Please complete this form to register for our Adult Tech Workshops.

Student Information

Full Name

Birthday (18 and older)

Month

Day

Year

Email

Phone

Address

Gender

Female

Male

Emergency Contact

Emergency Contact Full Name

Relationship To Student

Emergency Phone Number

Emergency Email

Health & Safety

Do you have any allergies, medical conditions, or accessibility needs (e.g., vision, hearing, mobility) that we should be aware of to ensure a comfortable learning experience?

No

Yes (please explain below)

List of allergies or medical conditions

Camp Selection

Student Experience & Interests

Have you attended a Adult Tech camp before?

Yes

No

If you answered "Yes" to the previous question, please provide the class name or services, dates and results of your learning experience.

What do you hope to learn from your training with us?

Acknowledgments

Photography & Media Release

I grant permission for my image or likeness to be photographed, recorded, or used in promotional materials, publications, or online platforms by the Tech Time Cincinnati Foundation to promote its programs.

Yes

No

Signatures

Full Name

Date

Month

Day

Year

Signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Thank you for registering! Submitting this form is completely free. Please check your email for a message containing your workshop's details, location, and payment link. Your spot in the workshop will be officially secured only once payment is received.

Check To Verify

Donate to our scholarship program so other low income students may have the same opportunity learn from our programs.

$10

$20

$30

Tech It Easy With Us!