Kopanya - Talking to Kids about Race and Racism - Registration Form (2025)

Thank you for your interest in Kopanya's "Talking to Kids about Race and Racism" course, which is offered either as a self-study or facilitated group option.

To register, please provide us with some background information. All the information you provide here will be kept confidential and will not be shared with anyone without your permission.

Once we receive this information, we will send you more detailed information about the course, including facilitator profiles, process for payment, etc.

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* 1. Please provide us with your personal details:

First Name (preferred name):

Surname:

Location (where do you live):

Date of birth:

Profession or area of study:

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* 2. What sparked your interest to join this course?

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* 3. Name one challenge around race/racism that you are currently sitting with:

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* 4. Name one conversation or experience where you felt empowered and/or encouraged in talking about race or racism?

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* 5. We have designed the course to offer value whether you have children in your life or not, so it will help us to know the following:

Do you currently have children or young people in your life?

If so, what are their ages?

What is one of the most challenging questions they have asked you about race?

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* 6. What do you hope to get out of this course? Is there anything specific you would like for us to look at?

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* 7. Please indicate whether you would prefer to be part of the facilitated group option or to do the course as a guided self-study:

Facilitated group

Guided self-study

Not sure yet

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* 8. Where did you hear about this course?

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* 9. Please provide us with your contact information:

Email address:

Cell phone number:

Do you have WhatsApp? (and is it the same as your cell # above?)

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* 10. Do you have any (dis)ability that you would like us to be aware of so that we can better accommodate you on the course?

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* 11. As mentioned above, we don't want cost to be a barrier for anyone. If you would like to be considered for a subsidised rate or payment plan to attend the course, please let us know your reasons below.

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* 1. Please provide us with your personal details:

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* 2. What sparked your interest to join this course?

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* 3. Name one challenge around race/racism that you are currently sitting with:

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* 4. Name one conversation or experience where you felt empowered and/or encouraged in talking about race or racism?

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* 5. We have designed the course to offer value whether you have children in your life or not, so it will help us to know the following:

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* 6. What do you hope to get out of this course? Is there anything specific you would like for us to look at?

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* 7. Please indicate whether you would prefer to be part of the facilitated group option or to do the course as a guided self-study:

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* 8. Where did you hear about this course?

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* 9. Please provide us with your contact information:

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* 10. Do you have any (dis)ability that you would like us to be aware of so that we can better accommodate you on the course?

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* 11. As mentioned above, we don't want cost to be a barrier for anyone. If you would like to be considered for a subsidised rate or payment plan to attend the course, please let us know your reasons below.

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* 12. Anything else you would like for us to know?