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

Select One

Summer Pro (2 days) 10a-1pm

Summer Explorer (1 day) 10a-2pm

Smart Home Tech (90mins)

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

Payment

Choose Your Payment Method:

Credit/Debit Card

Scholarship Application

Private Sponsor

Next Steps

You will receive a confirmation email with camp details after your enrollment payment is processed completely. For questions, contact us at 513-443-5144 or 230 Northland Blvd, Cinti, Ohi 45246

Signatures

Full Name

Date

Month

Day

Year

Signature

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

Check To Verify

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

$10

$20

$30

Tech It Easy With Us!