Opening Hearts and Minds to Creative Leadership & Advocacy
Saturdays: February 6th - March 27th
* Required
Welcome to the 2021 Winter/Spring Registration Form!
Safety first! Please supply your information in case we need to contact you or in case of an emergency.
Please fill out a separate form for each child you wish to register. Thank you!
Parent's Name
*
Your answer
Parent's Information:
Please tell us about yourself
Address
*
Your answer
City, State, Zip
*
Your answer
Phone
*
Please include area code with periods (ie. xxx.xxx.xxxx)
Your answer
Email
*
Your answer
Employer
*
Your answer
How did you hear about our program?
Your answer
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