http://www.bernardsvillelibrary.org/

Special Needs Code Club for Ages 12-17 with Caregiver (March-April)

Question Title

* 1. Teen’s first and last name.

Question Title

* 2. Teen's grade

Question Title

* 3. Telephone number of parent or care giver.

Question Title

* 4. Telephone number of another parent/caregiver for emergencies

Question Title

* 5. Does your teen have any health-related problems or allergies to food, glue, crayons, etc.?

Yes

No

Question Title

* 6. If you answered yes, please comment:

Question Title

* 7. E-Mail Address (helpful if you would like to receive class information and potential cancellations)

Question Title

* 8. Thank you for registering!