MLK Registration Form
Douglas-Carroll-Paulding Counties Alumnae Chapter
Full Name
*
First Name
Last Name
Email address
*
Phone number
*
Cellular number preferred
Name of School
Grade level /Registration status
*
4th or 5th grade (parent attendance mandatory)
Middle
High
Parent
DCP member
Guest
Parent's Name
*
First Name
Last Name
Parent's Email
example@example.com
Parent's Phone Number
*
-
Area Code
Phone Number
Do you have any food allergies?
*
Yes
No
List food allergies
*
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Next
Select which workshops you're interested in?
MLK projects, Living the Dream
STEAM Expo, Make Your Dream, STEAM
*Hold Shift to select up to 3
Select which workshops you're interested in?
The Poison Pump
MLK projects, Living the Dream
STEAM Expo, Make Your Dream, STEAM
*Hold Shift to select up to 3
Select which workshops you're interested in?
Be your Own Boss
The Poison Pump
College readiness ACT/SAT prep and more
STEAM Expo, Make Your Dream, STEAM
Stress management
Teenagers and Money
What to do after High School?
*Hold Shift to select up to 3
Select which workshops you're interested in?
Help! I'm raising a teenager...Parent tips
It's not too late to change careers!
Technology Tips for Parents...Navigating social media
*Hold Shift to select up to 3
How did you hear about this event?
*
School
Community organization
Friend/family
DCP member
Do you have any questions?
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Next
As the parent or guardian of the student named above, I give permission for my student to participate in the annual youth forum. I consent to my student's picture while participating in the event to be used by DCP in connection with reporting the success of the event to Delta Sigma Theta Sorority, Inc. I also understand that a parent or guardian must accompany my 4th or 5th grade child.
*
Yes
No
Submit Registration
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