TAY - Digital Design
Please fill out the following questions, we want to provide the best experience for your young creative as possible. Thank you for your time.
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Student First Name *
Student Last Name *
Parent or Guardian First Name *
Parent or Guardian Last Name *
Phone Number *
Email Address *
Has your child participated in a Squeaky Wheel education program previously? *
Are you a Squeaky Wheel Member? *
Does your Child have any food allergies? *
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? *
I grant to Squeaky Wheel/Buffalo Media Resources the right to take photographs of my family and me 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. *
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