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 Thursday, June 30, 2016.
  • 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