Changemakers Cohort Interest / Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Parent / Guardian First and Last Name *

Parent / Guardian Email *

Are you interested in your child(ren) participating in the program, "Changemakers: Made to Make a Difference"? *

Yes

Maybe

Other:

Child #1 Name, Age, and Grade for 2026-2027 *

Child #2 Name, Age, and Grade for 2026-2027

Child #3 Name, Age, and Grade for 2026-2027

Have you reviewed the dates and times the program will meet? *

Yes

Do your child(ren) commit to being at 7 out of the 9 planning meetings? *

Yes

Other:

Do your child(ren) commit to being at the first meeting on September 13th? *

Yes

Maybe

Please share your thoughts, feedback, and questions

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Irvine United Congregational Church.

Does this form look suspicious? Report