Self Publishing Workshop Registration Form

From Pen to Published: Crafting Your Own Book

Hosted by: Family Academy Presented by: Authors for the Culture & Books 2 Inspire
Unleash your creativity and bring your stories to life! This workshop takes students through the entire self-publishing process - from brainstorming ideas and writing drafts to editing and designing their very own published book.

We encourage students to come with a book idea in mind. Supplies will be provided; however, you are welcome to bring more.

This is a drop off event for Durham Public Schools middle and high school students.
Parent/Guardian Name*
Name of Youth*
Age of Youth*
Please share any allergies your child may have
If applicable
Name of Youth*
Enter N/A if you are not registering more than 1 child/youth
Age of Youth*
Enter N/A if you are not registering more than 1 child/youth
Please share any allergies your child may have
If applicable
Parent/Guardian Phone*

Area CodePhone Number
Parent/Guardian E-mail *
This is where your receipt and communication will be sent
Disclaimer
Please read the following Terms & Conditions. 

Consent to Photograph /Videotape/Interview Individuals: 

I hereby agree and give my permission for Rare Optics and/or partners to record, film, photograph, audiotape or videotape my child(ren) (hereinafter collectively referred to as “Works”) and to display, publish or distribute these Works for the purpose of publishing, posting on the Rare Optics website and posting on social media sites. I hereby waive any right to approve the use of these Works now or in the future, whether the use is known to me or unknown, and I waive any right to any royalties related to the use of these Works. I understand that the Works may appear in electronic form on the internet or in other publications outside of Rare Optics’ control. I agree that I will not hold Rare Optics responsible for any harm that may arise from such unauthorized reproduction.
Consent
I am over 18 years-of-age and I have read this waiver and agree with its content.
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Parent/Guardian Signature*

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From Pen to Published: Crafting Your Own Book