Participant Name *

First Name

Last Name

Participant Phone *

Country

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Name (if under 18)

First Name

Last Name

Parent Phone (if under 18)

(###)

###

####

We will upload the video to Youtube (unlisted and send House of Kala the link by the deadline June 30, 2024 6:00pm PST) *

Yes

No

If selected for Phase 2, I/my family will arrange for travel to Renton , WA and stay in one of the recommended hotels *

Mandatory requirement for the grant that is partially funding the program

Yes

No