2019 I AM DEFENSE REGISTRATION FORM
STOP! TEXT @IAMINFO to phone number (81010) for class updates and info.
Complete a separate registration form for EACH CHILD.
iamdefense.com 678-408-2053 PO BOX 87401, COLLEGE PARK, GA, 30337
Email address *
STUDENT NAME *
Your answer
SCHOOL *
Your answer
STUDENT'S AGE *
Your answer
PARENT OR GUARDIAN ADDRESS
If different from student
Your answer
PARENT OR GUARDIAN NAME *
Your answer
BEST CONTACT NUMBER *
ex: 404.777.9311
Your answer
EMAIL *
Your answer
GRADE LEVEL *
EMERGENCY CONTACT NAME #1 *
Your answer
EMERGENCY CONTACT PHONE NUMBER *
Your answer
HOW DID YOU LEARN ABOUT THE PROGRAM? *
WHAT DO YOU WANT YOUR CHILD TO LEARN? PLEASE CHECK ALL THAT APPLY *
Required
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