Grounded & Unshakeable Part 1 Registration

Registration Form

Enter your full name, email, phone number, and address to complete registration.
Participant's Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Name
Age
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade
School
Parent/Guardian Full Name

First NameLast Name
Relationship to Participant
Secondary Parent/Guardian Name

First NameLast Name
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Relationship to Participant
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does your child have any allergies, medical needs, accessibility needs, or other information that would be important for the workshop facilitator to know in order to provide a safe and supportive experience?
Please share only information that is relevant to your child's participation in this workshop.
Parent/Guardian Consent
Payment & Cancellation Policy
Parent/Guardian Name

First NameLast Name
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Registration Fee
Grounded & Unshakeable — Part 1 September 26, 2026 | 1:00–3:00 PM $65

Grounded & Unshakeable

$65.00 Quantity

Total

Registration Form