Workshop Registration: Student Information
Please note that each student is restricted to participating in two workshops per season.
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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