TAG Motion Graphics

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TAG Motion Graphics

Please fill out the following questions, we want to provide the best experience for your young creative possible. Thank you for your time.

Young Creative's Name *

Name of Parent or Guardian *

Phone Number *

Email Address *

Has your child participated in a Squeaky Wheel education program previously? *

Yes

Are you a Squeaky Wheel Member? *

Yes

Does your Child have any food allergies? *

Yes

If so please explain.

Are there any other cognitive or behavioral issues that we should be aware of? (All information is confidential)

How did you hear about our workshops? *

Our Website

Facebook/Social Media

From a friend

Poster/Flyer

Squeaky's Seasonal Calendar

Other:

I grant to Squeaky Wheel/Buffalo Media Resources the right to take photographs of me and my family in connection with this event or workshop. I authorize Squeaky Wheel/Buffalo Media Resources, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Squeaky Wheel/Buffalo Media Resources may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. *

Yes

Other:

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