Pumpkin Patch Registration Form

Pumpkin Patch Registration Form

Fill out the form carefully to register a youth between ages 8 and 12 for a 3 session workshop for pumpkin carving or hand-building clay pumpkin workshop, October 16th, 23rd, and 28th.
Location: Little Black Pearl Workshop

1060 E 47th Street

Chicago, IL 60653

Time: 3:30pm to 5:30pm

*Snacks will be provided.*
Youth Name*

First NameLast Name
Birth Date

MonthDayYear
Gender
What school does the youth attend?
School Name
Parental Guardian Name

First NameMiddle InitialLast Name
Phone Number*
Parental Guardian
Email*
Parental Guardian Email
Workshop*
Select a workshop.
Dietary restriction*
Please inform us of any food allergies.
Should be Empty: