2017-18 TEENS ACTING FOR SOCIAL CHANGE (TASC) REGISTRATION
Dear New and Returning Parents,

Welcome to the 2017-18 TASC year, and welcome to our BWC community! This registration form is required in order for your child to participate in TASC. Feel free to contact me with any questions. View the full TASC calendar here: tinyurl.com/TASCcal17-18

Liz Krushnic
liz@circleboston.org

Boston Workmen's Circle Membership
Family Membership at Boston Workmen's Circle is required for all TASC families. Click here to complete the membership form: bit.ly/2017-2018BWCMembership. (Please note: single parents may join BWC at the "Individual" rate.)
Student Information
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First Name
Your answer
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Last Name
Your answer
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Student Email
Your answer
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Student Cell
Your answer
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Student's preferred form of communication:
Required
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My child can do group texts
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Birth Date
MM
/
DD
/
YYYY
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2017-2018 School Grade
Your answer
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Please let us know about your child's needs, abilities, and experience. Please include any allergies, medical needs, or learning issues the coordinator needs to be aware of.
Your answer
Parent/Contact Information
Parent #1 *
First Name
Your answer
*
Last Name
Your answer
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Street Address
Your answer
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City
Your answer
*
State
Your answer
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Zip Code
Your answer
Check if this is a new address
Occupation/Useful Skills
Your answer
Contact Information *
Cell #
Your answer
*
Home #
Your answer
*
Email
Your answer
Parent #2
First Name
Your answer
Last Name
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Check if this is a new address
Occupation
Your answer
Contact Information
Cell #
Your answer
Home #
Your answer
Email
Your answer
Other Information
Medical Form *
All students must have a current medical form on file. Please download and complete the medical form by clicking here: tinyurl.com/2017-2018TASCMedConsentForm.
Required
BOSTON WORKMEN'S CIRCLE PHOTO PERMISSION FORM *
I/we hereby grant permission to Boston Workmen's Circle to use a photograph/video of our child(ren) and/or me/us, without identifying information, in any printed or electronic materials.
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