The Re-Education Project 2023 Youth Programs Registration Form
Complete this registration form for all 2023 programs:
  • Summer Program (includes African Language Program and Watato Book Club)
  • Rites of Passage Program
  • After-school Program: Pan-African Congress (for partner schools only) 
  • After-school Program: Ase African and Diasporic Dance and Drum Academy (for partner schools only)

***Please click here or visit our website for all program details.***

For your convenience, you may register for multiple programs by completing the form once. 

Important: Payment for the respective program(s) is due at the time of registration.

Space is very limited for all programs so early registration is highly encouraged. Registration is not complete until both this form and the payments have been submitted. Once we've reached our capacity, no more registrations will be accepted for the respective program/session.

***Please complete one form per student/child of respective parent.***

Payments can be submitted in one of two ways: 
In the subject line, write the student's full name and the program name(s).

To learn more, visit our website and connect with us on social media.

For questions, email TheReEducationProject@gmail.com. 

Sign in to Google to save your progress. Learn more
Email *
Today's Date *
MM
/
DD
/
YYYY
Which program(s) are you registering for? *
Refer to our website or click here for specific program details, dates, and payment information. If you select multiple programs, be sure to submit payments according to the respective payment schedules.
Required
First and Last Name of Student: *
Gender *
Race *
Culture *
Age (as of February 1st, 2023) *
School (2022 - 2023 School Year): *
School (2023 - 2024 School Year): *
Home Street Address *
City *
County *
State *
Zip Code *
Country *
Neighborhood/Side of Town *
Parent/Guardian Full Name: *
Parent/Guardian Email Address: *
Parent/Guardian Cell Phone Number *
Parent/Guardian Phone Number #2 (secondary number) *
Person Authorized To Pick Up Student *
Include full name, cell number, email address, home address, and relationship to student.
Emergency Contact Name: *
Emergency Contact Relationship: *
Emergency Contact Phone: *
Health, Allergies, and Neurodiversity *
Please describe any health, allergy, or neurological variations that your student may have. We recommend that those with variations are assisted by someone while completing the program as one-on-one assistance is not currently available. Write N/A if this does not apply.
Snacks
Snacks will be provided however we recommend that students with specific dietary needs (i.e. food allergies, vegan, vegetarian, gluten-free, etc.) bring their own snacks.
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms