LAHC Youth Listening Circle Registration Form
Student Name
*
First Name
Last Name
Student Email
*
example@example.com
Student Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Name
*
First Name
Last Name
Parent Email
*
example@example.com
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Which of these dates and times work for you to attend the Listening Circle Lunch? (Please choose all that apply)
*
Monday, Dec. 22nd at 1:00 PM
Monday, Dec. 29th at 12:00 PM
Monday, Dec. 29th at 3:00 PM
Which of these dates and times work for you to attend the Listening Circle Lunch? (Please choose all that apply)
*
Monday, Dec. 29th at 12:00 PM
Monday, Dec. 29th at 3:00 PM
Which of these dates and times work for you to attend the Listening Circle Lunch? (Please choose all that apply)
*
(Virtual) Wednesday, February 11th from 4:00 PM to 4:45 PM
Submit
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