Section One - Participant/Student Information
All questions are required
Participant Name
*
First Name
Last Name
Participant Cell Phone Number
*
-
Area Code
Phone Number
Participant Age
*
Participant's School
*
Section Two - Parent Information
The next section is all about the Parent or Guardian of the participant
Name of Parent or Guardian
*
First Name
Last Name
Parent Cell Phone Number
*
-
Area Code
Phone Number
Parent Email
*
example@example.com
Section Three - Other information
Please describe any struggles or challenges the participant may be having.
*
Does the participant have a counselor or therapist?
*
Yes
No
Please describe any support the participant has received from church.
*
Does the participant have any hopes or expectations for this workshop?
Please list any food allergies the participant has. If none, please type "none".
If the allergy causes anaphylaxis please specify
Section Four - Consent
Upon submitting you will be redirected to a REQUIRED consent form. This form must be completed for your registration to be complete.
*
I understand that I must fill out the consent form that I will be redirected to after clicking submit.
*
I understand that there is a minimum $50.00 donation to the Foundation which covers lunch and workshop materials.
Submit
Should be Empty: