Clone of Blondena's HEIRS Youth Programming Interest Form

2026 Roots & Roofs Youth Workshop Registration Form

Blondena's Heirs is a nonprofit organization empowering African American families to protect legacy, resolve disputes, and plan for inheritance. HEIRS = Heritage, Equity, Inheritance Resources. This summer we are offering our youth workshop series, Roots & Roofs, for students between the ages of 10-14 years old at various libraries across the Chicagoland area and surrounding suburbs. Please fill out the form below to receive additional information and pre-register up to 5 students for a single-day workshop in your neighborhood of interest.
Contact Information
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone Number

Area CodePhone Number
Parent/Guardian Email
example@example.com
Student Name 1

First NameLast Name
Student 1 Age
Student Name 2

First NameLast Name
Student 2 Age
Student Name 3

First NameLast Name
Student 3 Age
Student Name 4

First NameLast Name
Student 4 Age
Student Name 5

First NameLast Name
Student 5 Age
How did you hear about us?
Desired Workshop Date, Time, & Location (subject to change)
Follow-up information

This interest form will be reviewed by a member of our team. We will reach out to the email address provided with additional information as needed.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Should be Empty:

2026 Roots & Roofs Youth Workshop Registration Form