Registration Form for PLF4M for Walden CITs & Staff

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We cannot wait to complete this course with you!

PLEASE HAVE A PARENT/GUARDIAN FILL OUT THIS FORM.

Email *

Please check below: *

I am a parent/guardian filling out this registration form for my child

Required

Parent's First and Last Name: *

Parent's Phone Number: *

Student's First and Last Name: *

At Walden, my child lives in a: *

Boys Cabin

Girls Cabin

At Walden, my child is a: *

CIT

STAFF

Student's Date of Birth *

YYYY

Grade of the student in September 2026 *

Student's Email Address (cannot be a school or "GAPPS" email): *

Student's Home/Day School: *

Home Address: *

City: *

Postal Code: *

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