Wellness Wednesday Registration

2023 - 2024 Wellness Wednesday Registration
Participant Information
Last Name *
First Name *
Age *
Grade *
Email address *
If you would like a reminder of the workshop sent via text message list your cell # here:
I would like to register myself/my child for the following Wellness Wednesday Programs:*

Choose Good Friends & Build Self Confidence - Tweens (9-12) - 5/8/24
I would like to register Child#2 for a Wellness Wednesday Program

Yes
Last Name
First Name
Age
Grade
Email address
I would like to register myself/my child for the following Wellness Wednesday Programs:

Choose Good Friends & Build Self Confidence - Tweens (9-12) - 5/8/24
I would like to register Child#3 for a Wellness Wednesday Program

Yes
Last Name
First Name
Age
Grade
Email address
I would like to register myself/my child for the following Wellness Wednesday Programs:

Choose Good Friends & Build Self Confidence - Tweens (9-12) - 5/8/24
I would like to register Child#4 for a Wellness Wednesday Program

Yes
Last Name
First Name
Age
Grade
Email address
I would like to register myself/my child for the following Wellness Wednesday Programs:

Choose Good Friends & Build Self Confidence - Tweens (9-12) - 5/8/24
Parent/Caregiver Information (Not Necessary for Teens)
Name
Address 1
Address 2
City
State
Zip
Email Address
Should be Empty:

2023 - 2024 Wellness Wednesday Registration