To enroll a student, please complete the form below and mail tuition check to:

Media Poetry Studio
240 Carlester Dr.
Los Gatos, CA 95032

  • Tuition is $489 if enrolling by June 1. If enrolling after June 1, tuition is $589.
  • Make check payable to CALIFORNIA POETS IN THE SCHOOLS.
  • Tuition due date is June 30.
  • If you are unable to pay by check, please contact us to make other arrangements.
  • In case of cancellation, refunds are given at camp director's discretion. Cost of classes attended will be deducted from refund total. 
  • Please read our Parent/Provider contract. You can sign and send it with tuition or sign in person on the first day of camp. 

Parent / Legal Guardian
Parent / Legal Guardian
Street Address
Street Address
Cell or daytime phone
Cell or daytime phone
Home phone
Home phone
How did you hear about us?
Student 1
Student 1
Allergies / Medical Conditions / Medications / Special Accommodations / Other Notes
Student 2
Student 2
Allergies / Medical Conditions / Medications / Special Accommodations / Other Notes
Student 3
Student 3
Allergies / Medical Conditions / Medications / Special Accommodations / Other Notes
Emergency Contact 1
Emergency Contact 1
Relationship to student
Is this individual authorized to pick up student?
*Camp will not release students to individuals under the age of 18.
Cell or daytime phone
Emergency Contact 2
Emergency Contact 2
Relationship to student
Is this individual authorized to pick up student?
*Camp will not release students to individuals under the age of 18.
Cell or daytime phone
Emergency Contact 3
Emergency Contact 3
Relationship to student
Is this individual authorized to pick up student?
*Camp will not release students to individuals under the age of 18.
Cell or daytime phone
Use this section to specify other individuals authorized to pick up student (include full name and relationship to student) or to indicate other dismissal arrangements (student drives own car, student takes public transit, etc.). *Camp will not release students to individuals under the age of 18.
Use this section to include anything you wish to add.