Mr. Stevey & Friends Program Registration Form FY25

2024-2025 Mr. Stevey & Friends 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!
Parent Name*

First NameLast Name
Email*
example@example.com
Zip Code*
Are you a:*

ParentCaregiverChaperoneOther
If a Chaperone, what organization do you represent?
Do any of your school-aged children (K-12) participate in the Free or Reduced Lunch program at school?*

YesNoN/A

Please indicate the number of children with you today by grade level for the 2024-2025 school year:*

	Number of children with you today by grade level:
Pre-K
K-3rd
4th-5th
6th-8th
9th-12th

What is the race/ethnicity of the child(ren)? (If the children are different races, please explain in the 'Other' option below.)

Black/African AmericanWhite/CaucasianHispanic/LatinxAsianMixed RaceOther
How did you hear about us?

FacebookInstagramEventbriteFriend/Family MemberWalk-inChild's SchoolOther
Do we have permission to use photos of you and your child from this event for social media and promotional purposes?*

YesNo
I understand that photos and/or videos may be taken of my child/myself and grant permission of Sarasota Performing Arts Foundation (AKA Van Wezel Foundation) and/or news media to use my image/likeness in print, television, online, through social media and all other marketing, promotional, and informational materials. I hereby waive the right to inspect or approve recordings/photos, and their use in any materials as noted above. I hold the Sarasota Performing Arts Foundation, and all its employees, harmless against any complaint or suit that should arise from the use of my/my child’s likeness, photo or video, and understand that I will receive no monetary compensation for participating in the workshop and/or the use of my likeness.*

By clicking the submit button, I agree to terms & conditions above.
Thank you! Please press "Submit" below
If you have any questions, please contact us at: programs@PerformingArtsFoundation.org

or call

941-271-4181
Should be Empty:

2024-2025 Mr. Stevey & Friends Registration Form