Child Registration Form (for children age 3 and under)

Black and Female: What is the Reality?Child Registration Form

(FOR CHILDREN AGE 3 AND UNDER ONLY)
THIS FORM IS ONLY TO REGISTER CHILDREN 3 AND UNDER ONLY.

For yourself and children 4 years and over, please use the Be Present registration page to register each person.
Full Name*

First NameLast Name
Email*
example@example.com
Yes (Fill out child's name and date of birth below)No (Exit this form and use the Be Present website to register.)
The Children's Learning and Play (CL&P) Program ensures that children are full participants in the training and that they have support for additional movement and/or activities as necessary, in partnership with the parent(s) and/or primary caregiver.
Child 1 Name*

First NameLast Name
Child 1 Date of Birth*

MonthDayYear
Month-Day-Year
Child 2 Name

First NameLast Name
Child 2 Date of Birth

MonthDayYear
Month-Day-Year
Child 3 Name

First NameLast Name
Child 3 Date of Birth

MonthDayYear
Month-Day-Year
Child(ren) Physical Needs
Other Needs
Should be Empty:

Black and Female: What is the Reality?Child Registration Form