Workshop Registration: Student Information
Please take note of age restrictions before signing students up for workshops, and remember that each student is restricted to participating in two workshops per season. The upcoming Workshops season runs from April through mid-June.

**The following workshops are FULL, and open only for WAITLIST sign-ups:

-Reply All: Writing in Collaboration (Ages 11–13)
-Odes to Ordinary Objects (ages 8–11)
-Be Your Own Jedi: A Writing and Meditation Workshop (ages 11–13)

Workshop 1 (First choice)
Workshop 2 (Second choice)
Student's First Name *
Your answer
Student's Last Name *
Your answer
Grade *
Date of Birth (please make sure to select the correct year!) *
MM
/
DD
/
YYYY
School *
Your answer
Type of School *
Does your student qualify for Free or Reduced Price Lunch? *
Does your student have permission to walk home by themself? *
The following people are authorized to pick up this student:
Your answer
Student's Email (Optional)
Your answer
Student's Cell Phone Number (Optional)
Your answer
Is your student enrolled in an English Language Learner program (ELL/ESL)? *
If yes, what level has your student been assigned? (Please refer to your latest report card)
Your answer
Does your student have any special needs (e.g. learning, physical or mental health)? *
If yes, please explain:
Your answer
Does your student have an Individualized Learning Plan (IEP)? *
If yes, please explain:
Your answer
I give 826 Valencia permission to communicate these needs to volunteers in order to support their work with my student.
Student's First Language(s) *
Your answer
Language(s) Spoken at Home *
Your answer
Race/Ethnicity *
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