Private Sessions Registration Form

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Writopia Lab is committed to providing an inclusive and welcoming environment for all writers regardless of race, color, gender, national origin, age, religion, creed, physical or mental disability, sexual orientation, gender identity or gender expression.

About Your Writer

Writer's First Name *

Writer's Last Name *

School *

Date of Birth *

YYYY

Writer's Cell Phone

Writer's E-Mail

Allergies *

Does your child have any allergies? Please explain symptoms and what to do in case of emergency.

Is your child at risk for anaphylaxis? *

Yes

Precautions *

Please list all other medical conditions, mental health issues, or disabilities (physical or mental) of your child we should be aware of.

I am registering *

a returning writer.

a sibling of a writer who is already registered.

a new writer.

Zip Code *

Please use your home zip code to help us coordinate your private session.

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This form was created inside of Writopia Lab.