Stitch and Sew Youth Cohort Registration
Join Peoria Fashion Week Academy and 4-H for an engaging 8-week sewing class for youth ages 7–18. Prepare to learn and create in a fun environment.
Student Information
Student Full Name
*
First Name
Middle Name
Last Name
Student Age
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade
*
Please Select
6th
7th
8th
9th
10th
11th
12th
Other
School Name
Parent/Guardian Information
Parent/Guardian Full Name
*
First Name
Middle Name
Last Name
Relationship to Student
*
Please Select
Parent
Guardian
Grandparent
Relative
Foster Parent
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Home Address
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Program Details
Preferred start date confirmed
*
Yes
No
Sewing experience level
*
Please Select
No experience
Beginner
Some experience
Medical and Safety Information
Allergies or Medical Conditions
Special Accommodations Needed
Authorized Pickup Person(s)
Permissions
Photo and video release consent
*
I consent to the use of photos or videos taken during program activities
I do not consent
Liability waiver acknowledgment
*
I acknowledge and accept the liability waiver terms
Permission to participate in class activities
*
I give permission for the student to participate in class activities
4-H membership acknowledgment
*
I acknowledge that 4-H membership is required for participation
I acknowledge the membership requirement and will complete it if needed
Payment Section
Program fee: $150. This fee includes 4-H membership and supplies.
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Stitch and Sew Youth Class
$150.00
$
150.00
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Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
Payment option
*
Pay now
Need payment arrangements
Final Agreement
Parent/Guardian Signature
*
Date Submitted
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Which Cohort would you like to be apart of.
Tuesdays and Thursdays/ 6-8pm with Instructor Khalessi
Wednesday and Friday/ 5-7pm with Instructor Dwight
Register Today
Register Today
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