Mr. Stevey & Friends Program Registration Form FY24

Mr. Stevey & Friends Program Registration Form
Please complete this registration form. The information will help us to provide summary data to our grant funders so we can continue to offer FREE programs and resources. Thank you!
Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Zip Code*
Are you a:*

ParentCaregiverChaperoneOther
What organization do you represent?
Does your child/children participate in the Free or Reduced Lunch program at school?*

YesNo
How did you hear about us?

FacebookEventbriteFriend/Family MemberWalk-inOther
Do we have permission to use photos of you and your child from this event for social media and promotional purposes?*

YesNo
FIRST Name of Child #1*
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #2
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #3
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #4
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #4
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #5
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #6
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #7
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #8
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #9
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Do you have another child to register?*

YesNo
FIRST Name of Child #10
What grade is the child in?*
What school does the child attend?*
What is race/ethnicity of the child? *
Thank you! Please press "Submit" below

If you have any questions, please contact Allie at: ahunter@PerformingArtsFoundation.org or call 941-271-4181
Should be Empty: