Duck Pond Registration
This registration must be complete before attending The Duck Pond with your duckling along with the waiver link found below
Primary Parent First Name (caregiver/parent) *
Your answer
Primary Last Name (parent/caregiver) *
Your answer
What is your zip code *
Your answer
Primary Phone Number *
This will be used for check in at each visit ex: 123-456-7891
Your answer
What is your age *
Email address
This will not be sold, we send monthly newsletters and event promotional emails
Your answer
What is your gender? *
What best describes your current employment status? *
What is the primary language spoken in your household? *
What is the highest level of education you have completed? *
How would you classify yourself? *
What is your current household income? *
What is your current marital status? *
How many children under 5 do you have in your household? *
How many children over age 5 do you have in your household? *
How did you hear about The Duck Pond(choose as many that apply)? *
Required
Do you currently receive government assistance (CalFresh, CalWorks, WIC) for my family. *
I would like to volunteer at The Duck Pond at Gateway Community Center *
Volunteers receive a discount or free entry
I would like to receive email updates from The Duck Pond at Gateway Community Center *
I would like to receive email updates from Gateway City Church and The Duck Pond *
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