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Registration: Strategies for Using Technology at Home

1. Attendee Information

33% of survey complete.

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* 1. Please enter your first name, last name, and email address.

First Name

Last Name

Email

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* 2. Childcare will be available by Village Nannies at a cost of $15 per child for the 1 1/2 hour session. Space is limited and reservations are required. Would you like this service?

Yes

No

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* 3. If you would like to register for childcare services, please enter the names and ages of the children requiring babysitting during the event.

Child 1 Name:

Child 1 Age:

Child 2 Name:

Child 2 Age:

Child 3 Name:

Child 3 Age:

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* 4. I am a

mother

father

grandparent

nanny/caregiver

Other (please specify)

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* 5. What school(s) does your child(ren) attend?

School 1:

School 2:

School 3:

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* 6. How did you hear about this program? (Check all that apply)

School Newsletter

Alliance Newsletter

Email From The Alliance

Winnetka Kiosk

Local Press

Email From A Friend

Other (please specify)

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* 7. Please list any specific questions you are hoping to have answered?

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* 8. Are you registering for additional participants?

Yes

No