Reel Girls Application Form

Please complete the application below and pay registration fee ($40) via Continuing Education.

Your application is not confirmed until the registration is paid.

If you have additional questions, please email reelgirls@temple.edu.

Applicant Information

First Name *

Last Name *

Current Address

Address Line 1 *

Address Line 2

City *

State / Province / Region

Zip / Postal Code *

Country

Student's Email *

High School *

High School Graduation Year *

Name of Media or Art Teacher

Parent/Guardian Contact Info

First Name *

Last Name *

Same as Above Address

Same as Student's Address

If different, complete below.

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Daytime Phone Number *

Evening Phone Number *

Email *

Medical Information

We request medical information to ensure the safety of all students. It will remain confidential.

Please list any and all allergies student has to to food, medications, insect, pollens, chemicals, etc. *

Are any medical conditions present that we should be aware of?

Is your child currently under medical treatment or taking medication that we should be aware of? *

Additional Information

Please use the space above to communicate any condition or circumstance that may affect your child’s ability to participate in the workshop.

Emergency Contact

Name *

Relationship *

Cell Phone Number *

Leave this field blank

* Indicates Required Field

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Reel Girls Application Form