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
Submit
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