Animal Friends Class
Classes Start September 1st from 9 am - 10:30 am. The last class will be October 27th.
Participant 1
*
First Name
Last Name
Age of Participant 1
*
Participant 2
First Name
Last Name
Age of Participant 2
Participant 3
First Name
Last Name
Age of Participant 3
Participant 4
First Name
Last Name
Age of Participant 4
Guardian Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email (@arizona Emails are NOT Accepted)
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Payment Method Choice
*
ESA
Invoice
Cash
Check
Card
Other
Back
Next
Release of Liability and Waiver
Waiver Liability Consent
*
YES - I consent to signing the Release of Liability
NO - I do NOT consent to signing the Release of Liability
Photo Release
*
Yes - Unrestricted
No - Deny Permission
Waiver & Photo Release Signature
*
Date
*
-
Month
-
Day
Year
Date
Demographic Informationing
TRAK relies on grants to support its programs. Grantors frequently ask us for the following information, and your response is completely optional. Thank you!
Ethnicity
*
Prefer not to answer
White
Black or African-American
Asian
Native American
American Indian or Alaskan Native
From multiple races
Other
Household Income
*
Less than $10,000
$10,000-$24,999
$25,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000-$149,999
$150,000 or greater
Prefer not to answer
Submit
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