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
First Name
Your answer
Last Name
Your answer
Student Email
Your answer
Student Cell
Your answer
Student's preferred form of communication:
Required
My child can do group texts
Birth Date
MM
/
DD
/
YYYY
2017-2018 School Grade
Your answer
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
Street Address
Your answer
City
Your answer
State
Your answer
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.
Submit
Never submit passwords through Google Forms.
This form was created inside of Boston Workmen's Circle. Report Abuse - Terms of Service - Additional Terms