Kuumba Institute Drum Workshop Registration
DATES: Oct. 5, 2019 through December 2019 | Saturdays Only
10:00 AM - 2:00 PM
Ashé Cultural Arts Center's Youth Program
SUBMIT ONE FORM FOR EACH CHILD.
PAY ONLINE ONLY AFTER ALL REGISTRATION FORMS HAVE BEEN SUBMITTED.
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Address *
Your answer
City, State, Zip Code *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Child's School *
Your answer
Grade Level *
Race *
Your answer
Date of Birth *
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Gender *
Age *
Parent's/Guardian's Full Name *
Your answer
Parent's/Guardian's Phone Number *
Your answer
Emergency Contact's Name *
Your answer
Emergency Contact's Phone Number *
Your answer
List any medical issues, such as ALLERGIES, or any other conditions particular to your child that the staff needs to know. (If none, enter not applicable.) *
Your answer
Number of people living in household: *
Parental permission to use photos, film or any likeness of your child for promotional purposes only. *
Today's Date *
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