Clone of REGISTRATION - Protect & Play: YWCA 10.21.26

Protect & Play: Family Safety Night

Wednesday Oct. 21th | 6:00 - 8:30PM | Tri-County Area YWCA: The Complex 724 N. Adams Street, Pottstown PA
Workshop #1: Smarter Parents - FOR ADULTS

Parents/caregivers with children ages 2-12 will participate in our 2-hour Smarter Parents workshop, led by Mission Kids' trained facilitators. You'll learn how to talk about sensitive topics like boundaries, personal safety, and navigating today's digital world. This workshop will help you communicate effectively with your children and keep them safe. Parents/guardians of children ages 2-12 are welcome to attend without children.
Are you the parent, caregiver, teacher, or mentor of a child between the ages of 2-12?
Due to the subject matter of the "Smarter Parents" Program, children are NOT permitted to attend the workshop with parents.
Parent/Caregiver Name

First NameLast Name
Parent/Caregiver Email
example@example.com
Parent/Caregiver Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to register another parent/caregiver for this workshop?
Parent/Caregiver #2 Name

First NameLast Name
Is the person listed above the parent and/or caregiver of a child between the ages of 2-12?
Parent/Caregiver #2 Email
example@example.com
Parent/Caregiver #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to register another parent/caregiver for this workshop?
Parent/Caregiver #3 Name

First NameLast Name
Is the person listed above the parent and/or caregiver of a child between the ages of 2-12?
Parent/Caregiver #3 Email
example@example.com
Parent/Caregiver #3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to register one or more children between the ages of 4-14 for "Workshop #2: Child Safety Lesson"?
Workshop #2: Child Safety Lesson - FOR KIDS AGES 4-14

ALL CHILDREN ATTENDING THIS WORKSHOP MUST HAVE A PARENT/GUARDIAN PRESENT AT MISSION KIDS FOR THE FULL TWO HOURS. Kids ages 4-14 will join Mission Kids' trained facilitators for an age-appropriate lesson that teach them about digital safety. The hour-long program raises awareness of online risks and empowers kids to make safer choices both online and offline. For the second hour, children will enjoy fun activities with our team members and other children.
Child Name

First NameLast Name
Children attending this workshop must be ages 4-14. Due to subject matter, no other children are permitted to attend this event in any capacity. Please read and agree to the following statement:
Child Age
Children ages 4-14 participating in this workshop will be supervised by certified childcare employees of Mission Kids Child Advocacy Center. Is there anything we should know about the child listed above? (i.e. dietary restrictions, special accommodations, etc.)
Would you like to register another child ages 4-14 for this workshop?
Child #2 Name

First NameLast Name
Children attending this workshop must be ages 4-14. Due to subject matter, no other children are permitted to attend this event in any capacity. Please read and agree to the following statement:
Child #2 Age
Children ages 4-14 participating in this workshop will be supervised by certified childcare employees of Mission Kids Child Advocacy Center. Is there anything we should know about the child listed above? (i.e. dietary restrictions, special accommodations, etc.)
Would you like to register another child ages 4-14 for this workshop?
Child #3 Name

First NameLast Name
Children attending this workshop must be ages 4-14. Due to subject matter, no other children are permitted to attend this event in any capacity. Please read and agree to the following statement:
Child #3 Age
Children ages 4-14 participating in this workshop will be supervised by certified childcare employees of Mission Kids Child Advocacy Center. Is there anything we should know about the child listed above? (i.e. dietary restrictions, special accommodations, etc.)
Would you like to register another child ages 4-14 for this workshop?
Child #4 Name

First NameLast Name
Children attending this workshop must be ages 4-14. Due to subject matter, no other children are permitted to attend this event in any capacity. Please read and agree to the following statement:
Child #4 Age
Children ages 4-14 participating in this workshop will be supervised by certified childcare employees of Mission Kids Child Advocacy Center. Is there anything we should know about the child listed above? (i.e. dietary restrictions, special accommodations, etc.)
Would you like to register another child ages 4-14 for this workshop?
Child #5 Name

First NameLast Name
Children attending this workshop must be ages 4-14. Due to subject matter, no other children are permitted to attend this event in any capacity. Please read and agree to the following statement:
Child #5 Age
Children ages 4-14 participating in this workshop will be supervised by certified childcare employees of Mission Kids Child Advocacy Center. Is there anything we should know about the child listed above? (i.e. dietary restrictions, special accommodations, etc.)
Please read and agree to the following statement:
Please verify that you are human
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Protect & Play: Family Safety Night

Workshop #1: Smarter Parents - FOR ADULTS

Workshop #2: Child Safety Lesson - FOR KIDS AGES 4-14