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2023 VAPING WORKSHOP Registration Form / Formulario de Inscipicion para los TALLERES DE VAPEO 2023
Welcome, and thank you for your interest in our Vaping Workshops. Please fill out all the required sections in this form.
Bienvenido y gracias por su interés en nuestras clases de Vapeo. Favor de completar todas las secciones requeridas en este formulario.
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* Indicates required question
Name /
Nombre
*
Your answer
Phone Number /
Numero de Telefono
*
Your answer
Email Address /
Correo Electrónico
*
Your answer
Please select the class you are interested in attending. /
Seleccione la clase a la que le interesa asistir.
*
Wednesday March 29th / miercole 29 de marzo - 8:15 AM - 9:30 AM (at Alpha)
Friday March 31st / viernes 31 de marzo - 8:15 AM - 9:30AM (at Madison)
Tuesday April 18th / martes 18 de abril - 8:15 AM - 9:30 AM (at Pershing)
Wednesday April 19th / miercole 19 de abril - 8:15 AM - 9:30AM (at Washington)
Tuesday April 25th/ martes 25 de abril - 8:15 AM - 9:30AM (at Monroe)
Tuesday May 2nd/ martes 2 de mayo - 8:15 AM - 9:30 AM (at Millview)
Tuesday May 9th/ martes 9 de mayo - 6:00-7:00 PM (at MHS) (English Only)
Thursday May 11th/ jueves 11 de mayo - 6:00-7:00 PM (at MLK)
Required
Preferred Language /
Lenguaje Preferido
*
English / Ingles
Spanish / Espanol
Required
Name of one child attending MUSD school /
Nombre de un hijo(a) que asiste a la escuela de MUSD
*
Your answer
Childs School /
Escuela de su hijo(a)
*
Choose
Adams
Alpha
Berenda
Chavez
Millview
Desmond
Dixieland
Eastin-Arcola
Furman Elementary
Furman High School
Howard
La Vina
Lincoln
Madera High
Madera South High
Madison
Martin Luther King
Matilda Torres
Monroe
Nishimoto
Mt. Vista
Parkwood
Pershing
Sierra Vista
Virginia Lee Rose
Thomas Jefferson
Washington
Other Child's School of Attendance /
Escuela de asistencia de otro hijo(a)
Choose
Adams
Alpha
Berenda
Chavez
Millview
Desmond
Dixieland
Eastin-Arcola
Furman Elementary
Furman High School
Howard
La Vina
Lincoln
Madera High
Madera South High
Madison
Martin Luther King
Matilda Torres
Monroe
Nishimoto
Mt. Vista
Parkwood
Pershing
Sierra Vista
Virginia Lee Rose
Thomas Jefferson
Washington
Other Child's School of Attendance /
Escuela de asistencia de otro hijo(a)
Choose
Adams
Alpha
Berenda
Chavez
Millview
Desmond
Dixieland
Eastin-Arcola
Furman Elementary
Furman High School
Howard
La Vina
Lincoln
Madera High
Madera South High
Madison
Martin Luther King
Matilda Torres
Monroe
Nishimoto
Mt. Vista
Parkwood
Pershing
Sierra Vista
Virginia Lee Rose
Thomas Jefferson
Washington
Emergency Contact Information (Name and Phone Number) /
Información de Contacto de Emergencia (Nombre y Número de Teléfono)
*
Your answer
Media Release: Please indicate below if you permit to release your image, or comments for School District publications, advertising purposes ONLY /
Comunicado de prensa: indique a continuación si permite publicar su imagen o comentarios para publicaciones del distrito escolar, SOLO con fines publicitarios
*
Yes / Si
No
Also, marketing, educational organizations associated with the District, such as news media and newspapers. /
Además, marketing, organizaciones educativas asociadas con el Distrito, tales como medios de comunicación y periódicos.
*
Yes / Si
No
Radio and television on the district and/or school website and/or Social Media /
Radio y televisión en el sitio web del distrito y / o la escuela y / o redes sociales
*
Yes / Si
No
I grant permission for authorized personnel to utilize my student information for data tracking purposes /
Doy permiso para que el personal autorizado utilice la información de mi estudiante con fines de seguimiento de datos.
*
Yes / Si
No
By typing your name below, I hereby release MUSD from any damages or injuries claimed by the student or parent related to the production or distribution of the photo or image. /
Al escribir su nombre a continuación, libero a MUSD de cualquier daño o lesión reclamada por el estudiante o el padre relacionado con la producción o distribución de la foto o imagen.
*
Your answer
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