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Intergenerational Learning + Healing Program for Teens with 4Ward Inclusion & The Kota Alliance: Sign-up Form
SPRING SEMESTER RESERVATION OPEN NOW! This is an invitation to our Saturday Intergenerational Teen Learning + Healing Program's SPRING SERIES from March - May 2025. This form is to be filled out by teens (13-18) and their parents/guardians to join the school year program. 
      
Winter/Spring Program dates. Each Saturday the program runs from 11am-2pm.     
3/22        
3/29        
4/5        
4/12        
4/19        
4/26        
5/3 - End of Year Closing event

You can reach out for more information at deenalynn@kota-alliance.org if you have additional questions. We look forward to having you in the program!

Once you are registered a member of our program team will reach out to each of you (parent/guardian and teen participants) to check in prior to the program start date and will be your point of contact throughout the program. 
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Name of Student/Teen: *
Name of Parent: *
Home address: *
Teen Contact Info (email/cell): *
Parent/Guardian Contact Info (email/cell): *
In Case of Emergency Contact Info (email/cell): if this is the same as your parental/guardian contact info above just say "same as above." If there is anyone additional you want listed for in case of emergency please name them below and list their contact information (email/cell). *
Where did you learn about the program? *
What are your pronouns? *
Required
What is your ethnic/racial background? Check all that apply: *
Required
Do you have any accommodations/medical needs we should be aware of? Are there any supports you need to take part in this program? Please describe. *
Do you have any allergies or dietary restrictions? *
Parental approval (please read and print your name below to verify approval): I, the below signatory, am the guardian/parent of the listed student/teen above. I approve their participation in this program and can be reached at the above email/cell phone for verification of this approval.  *
What, if anything, else do we need to know about you? *
Additional comments or questions: *
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