2017 Gilmanton Summer CHILD CARE CLINIC
Gilmanton 2017 Child Care Clinic Registration, July 24-26, 10:30 AM-1:00 PM
Participant First Name:
11 years old
12 years old or older
Participant First and Last Name:
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Two or More Races
Prefer Not to Respond
Hispanic or Latino
Not Hispanic or Latino
Prefer not to respond
Registration Fees are $15.00 and the participant can bring to the first day of class. Confidential requests for partial or full scholarships are available.
I will send the full payment of $15.00 with my child the first day of class
I request a full or partial confidential scholarship, based on financial need.
Media/Photo Release: I, as parent/guardian, give permission for UW-Extension to use photographs which may include my child for Child Care Clinic educational display or media release. I understand that photographs of my child will NOT be taken or used without my permission.
Special Accommodations Needed:
Please complete the captcha before submitting the form.
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