Animation - Storytelling Registration Form
This form will register your child for animation classes at Palama! This program is for students, ages 8 – 13, who have some animation experience or previously completed an animation class at Palama Settlement.

Please fill out one form for each child!

When: Mondays from 3 – 5 p.m. (15 classes)
(Aug 23, 30; Sept 13, 20, 27; Oct 4, 18, 25; Nov 1, 8, 15, 22, 29; Dec 6, 13).
No class on Sept 6 (Labor Day) or Oct 11 (Fall Break).
Email *
Participant Information
This section will ask you information about the child you're signing up!
Participant's First Name *
Participant's Last Name *
Participant's Age *
Participant's Gender *
Participant's Grade *
Participant's Birthday *
MM
/
DD
/
YYYY
Home Phone Number *
Address *
Zip Code *
School name *
Does the participant have any medical conditions that we should be aware of? (ie. Asthma, Diabetes, seizures, heart problems, food allergy, drug allergies etc) *
Required
If yes, please provide information, and list any medications being taken.
Physician Name *
Physician Phone Number *
Medical Insurance Carrier *
Policy/Membership Number *
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