Clone of Application Form: RISING LOAVES at the Lawrence History Center, June 30

Application Form

RISING LOAVES at the Lawrence History Center, 6 Essex Street, Lawrence, MA 01840
June 29 - July 27, 2026

Program held Monday through Friday from 9 a.m. to 2 p.m. at the Lawrence History Center. Note: Program closed on Friday July 3, 2026 in observation of Independence Day.
Name*

First NameLast Name
Date of Birth / Fecha de nacimiento*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Cell Phone Number*

Area CodePhone Number
Home Phone Number

Area CodePhone Number
Current school
Grade in September 2026*

567
Photo Release: I give the Lawrence History Center permission to publish my child’s photograph and first name only on its web site, social media and in print materials for the promotion of the program to students and their families.

YesNo
Permission of Parent or Guardian

I give my child (named above) permission to participate in the Lawrence Student Writers Workshop at the Lawrence History Center (including participation in walking tours around the the Lawrence North Canal district and one or two field trips by bus to the Addison Gallery of American Art on the campus of Phillips Academy in Andover, MA).
Name of Parent or Guardian*

First NameLast Name
Signature of Parent or Guardian/Firma de madre/padre/apoderado*

Clear
Should be Empty:

Application Form