Workshop Registration
The information collected in this form is required for protection of our children, youth, families, and volunteers. All information will be kept in strict confidence and is only available to ministry leaders and supervisors who are responsible for recruitment, training and assignment of our volunteers (except when there is a court order for disclosure of information).
Family's Last Name: *
Your answer
Name of Parent/Guardian: *
Your answer
Address: *
Your answer
Postal Code: *
Your answer
City: *
Your answer
Phone Number (Cell): *
Your answer
Phone Number (Home):
Your answer
Email address: *
Your answer
Emergency Contact (name and phone number) *
Your answer
I am interested in... (select all that apply)
Please register ALL children attending (including siblings).
AGES 4-14 will be offered childcare, AGES 15+ will participate in Music Program.
(1)Name of child who require childcare:
Your answer
Please indicate whether this child has special needs or is a sibling
Date of Birth (MM/DD/YYYY):
Your answer
(2)Name of child who requires childcare:
Your answer
Please indicate whether this child has special needs or is a sibling
Date of Birth (MM/DD/YYYY):
Your answer
(3)Name of child who requires childcare:
Your answer
Please indicate whether this child has special needs or is a sibling
Date of Birth (MM/DD/YYYY):
Your answer
(4)Name of child who requires childcare:
Your answer
Please indicate whether this child has special needs or is a sibling
Date of Birth (MM/DD/YYYY):
Your answer
(5)Name of child who requires childcare:
Your answer
Please indicate whether this child has special needs or is a sibling
Date of Birth (MM/DD/YYYY):
Your answer
Are you the legal guardian for the child(ren)?
If not, please provide name and contact information of the legal guardian
Your answer
Additional Comments:
Your answer
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