Child Registration Form (for children age 3 and under)

Child Registration Form

ONLY for registration of children 3 years of age and under.
THIS FORM IS TO REGISTER CHILDREN 3 AND UNDER ONLY.

For yourself and children 4 years and over, please use the website registration page to register each person.
What is the event you are attending?

Black & Female: What is the Reality?™ Celebration Retreat and TrainingTrailblazing Conference
Full Name*

First NameLast Name
Email*
example@example.com
Will you be attending with child(ren) 3 years or younger?*

YesNo
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(ren) Physical Needs
Other Needs
Should be Empty:

Child Registration Form