Education Enrichment Program Event Registration

Please complete the form below. Be sure to specify the name of the education event(s) or program(s). You may register your child for more than one event on the same form. If you want to register more than one child, please fill out a separate form for each child.
Education event or program name
Participant full name child or adult
Parent name if child participant
Street address with city state zip
Participant grade completed by the end of this school year
Participant date of birth
Email address
Work phone number
Cell phone number
Home phone number
Emergency contact name phone
Participant brief health history
Participant food allergies
Electronic signature and date