Yuma Early Literacy Project Workshop Enrollment Form
Please fill out all the information boxes below.  Completing this form will provide one adult registration for the Yuma Early Literacy Project Workshops and registration for your children ages birth through age 5.  

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Last Name *
First Name *
Address *
City *
Zip Code *
Phone Number *
E-mail address
I have access to a computer at home or at work *
Required
I am attending the workshop series as a *
Required
How did you hear about the workshop series? *
Required
Workshop Series Registration
Please indicate which Yuma Early Literacy Workshop Series that you plan to attend. You may sign up for an entire series or individual workshops.
Sierra Vista Presbyterian Church - Thursday 5:30-7:30 PM
150 West 28th Street, Yuma, AZ 85364 - Note: Please remember that you may sign up for a series even if you are not able to attend all of the classes in the series.
Antioquia Assembly of God Church - Thursdays, 5-7pm
10409 Helen Street, Wellton - Note: Please remember that you may sign up for a series even if you are not able to attend all of the classes in the series.
Please indicate the workshop language preference. *
What language is the primary language spoken at home? *
Required
Child Care Registration
Please be sure to register ALL the children that will attending the Child Care sessions.  If you have no children attending, please mark required fields with N/A.
1st Child's Name *
You are registering this child to be in the child care area for this workshop time.
1st Child's age (Needs to be between 0-age 5) *
Any other information about your child that we should be mindful of? *
2nd Child's Name
You are registering this 2nd child to be in the child care area for this workshop time.
2nd Child's age (Needs to be between 0-age 5)
Any other information about your child that we should be mindful of?
3rd Child's Name
You are registering this 3rd child to be in the child care area for this workshop time.
3rd Child's age (Needs to be between 0-age 5)
Any other information about your child that we should be mindful of?
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