Salir Adelante! Pathways for Our Future: Registration

¡Salir Adelante! Pathways for Our Future

Helping Iowa Latinx parents and their middle/high school youth pursue their educational and career goals. This course meets for 6 weeks on Tuesdays, beginning February 7 - March 14 at the Henry County Extension Office. Meal is served at 5:30pm and program runs from 6-8pm. Childcare will be provided on site for younger family members.
Parent/Guardian Name *

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com

7th - 12th Grade Youth Participating in Program*

Number of Younger Children Needing On-Site Childcare*
We will provide childcare on-site for younger family members while adults/older children are busy with the program.
List any dietary restrictions or food allergies of any family members attending the program
List disability assistance and/or other reasonable accommodations necessary to fully participate in the program
Should be Empty:

¡Salir Adelante! Pathways for Our Future