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KIDS CAN COOK REGISTRATION
Southwind Extension District is sponsoring FREE cooking classes for youth to learn more about kitchen self-care skills. The classes are for youth that have completed the second through fifth grades. Younger or older children will not be allowed.

Since this is a ‘hands-on’ experience, we limit the size of each class depending on the size of the facility. If you have questions please call Kathy McEwan at 620-365-2242 or email kmcewan@ksu.edu.

Instructors for the classes will be Nutrition Assistants Terri Kretzmeier, Malynda Payne, and Mary Daniels, and Kathy McEwan, FCS Agent for Southwind Extension District. Extension Master Food Volunteers will also assist.

Choose preferred class - Choose only one. *
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Child's Last Name *
Please register only 1 child per form.
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Child's First Name *
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Mailing Address *
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City and Zip code *
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Grade Just Completed *
Child's Age *
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Child's Gender *
Primary Emergency Contact Name *
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Emergency Contact Phone Number *
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Health Information *
Please list any known allergies (ESPECIALLY FOOD ALLERGIES) or chronic health conditions of which instructors should be aware. If no allergies are known, please enter 'none.'
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Parent's First Name *
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Parent's Last Name *
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Parent's Email *
Please check for accuracy
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Home Phone
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Parent's Work Phone *
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Parent's Cell Phone *
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Alternate Emergency Contact Name *
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Alternate Emergency Contact Phone Number *
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Name of Child's Doctor *
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Parent / Guardian Permission Agreement *
By electronically sumitting this registration form, I (parent/guardian) understand participants will be supervised and that if a serious illness or injury develops, medical and/or hospital care will be given. I hereby give permission to the attending physician to hospitalize and/or secure proper treatment for my child. I hearby release K-State Research & Extension, the State of Kansas and their agents, officers and employees, from all claims, demands and causes of action of any kind, including claims of negligence, which may arise from participation of my minor child in "Kids Can Cook" classes. I also authorize K-State Research & Extension or thier assignees to record and photograph my child's image and/or voice for use in research, educational and promotional programs.
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