C3Brix Registration Form

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IMPORTANT DETAILS:
* Admission is free

* Space is limited (60 max, including children and participating adults)

* All children must be accompanied by an adult

* Questions? Please contact Kerrie Gawrys (kerriegawrys@gmail.com)

Email *

Parent/Guardian/Caregiver Contact Information

First Name *

Last Name *

Phone/Cell *

I am signing up (check all that apply) *

A child/children for this event

Myself or another as adult participant/s

Required

How many children are you signing-up for this event?

Please tell us the child/children's names and ages here

Child 1 (full name, age)

Child 2 (full name, age)

Child 3 (full name, age)

Child 4 (full name, age)

How many participating adults are you signing-up for this event?

Please tell us the adult name/s here

Adult 1 (full name)

Adult 2 (full name)

A copy of your responses will be emailed to the address you provided.

Submit

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