Bodywise Health Education Enrollment
This is the form for enrolling in Bodywise Health Education. You will need to fill out this form for each child and then follow the link at the end to finish your registration and pay the class fee.
What is the first name of the child that will be attending? *
Your answer
What is the last name of the child that will be attending? *
Your answer
What are the child's pronouns? (She/her, they/them, he/him, ...?) *
Your answer
What is the child's date of birth? *
Your answer
What is your full name (the adult who's completing this registration)? *
Your answer
What is your email? *
Your answer
What is your phone number? *
Your answer
Does the child have any food allergies? (Snacks will be provided at each class.) If so, please describe AND contact me at rae@scandentlearning.org at least 10 days before the class. *
Your answer
Does the child have any special needs that will require accommodations? If so, please describe AND contact me at rae@scandentlearning.org at least 10 days before the class. *
Your answer
What is your child's experience with health/sex/puberty education? (Taken a class before? Talked about it at home? Comfortable or uncomfortable? Etc?) *
Your answer
Do you or your child have any particular questions or topics that you hope to see covered in this class? (If you wish to provide more detail than what fits here, please email me at rae@scandentlearning.org.)
Your answer
What is the full name of a parent/guardian or other adult who can be contacted in case of emergency? *
Your answer
Emergency contact phone number? *
Your answer
Is there anything else I should know about your child?
Your answer
Thank you for enrolling in Bodywise Health Education. To complete your registration, click Submit below, and then follow the instructions to pay for your class. If you are registering for more than one student, please click Submit, then complete this enrollment form for each student, and submit payment. Thank you.
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