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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