Mindfulness for Children & Youth
Registration for Children's Mindfulness Classes at High Plains Church
Primary Contact Adult
*
First Name
Last Name
Secondary Contact Adult (if applicable)
First Name
Last Name
How Many Children/Youth Are You Registering?
*
1
2
3
4
Child/Youth's Name
*
First Name
Last Name
Child/Youth's Current Age
*
2nd Child/Youth's Name
*
First Name
Last Name
Child/Youth's Current Age
*
3rd Child/Youth's Name
*
First Name
Last Name
Child/Youth's Current Age
*
4th Child/Youth's Name
*
First Name
Last Name
Child/Youth's Current Age
*
Preferred Contact Number
*
-
Area Code
Phone Number
Can you receive Texts on this number?
*
Yes
No
Primary Contact E-mail
*
Submit Form
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