Question Title

* 1. Parent name attending (first and last):

Question Title

* 2. Name of child (first last) who you will be representing (recommended for current 8th graders, however 7th through 11th graders are eligible to attend). If more than one child, list all names here with a "," between each full name.

Question Title

* 3. Total adults and children attending the workshop (DO NOT count children that will attend child care)?

Question Title

* 4. What school does the child you will be representing attend?

Question Title

* 5. What grade(s) is the child you will be representing?

Question Title

* 6. Check the event date you plan on attending.

Question Title

* 7. Please enter a daytime contact phone number if we need to reach you?

Question Title

* 8. Please enter an email address where we can reach you if needed?

Question Title

* 9. How do you hear about this program (mark all that apply)?

Question Title

* 10. Will you be requiring child care (ages 3 to 11)?

Question Title

* 11. List any other comments or information if desired.

T