UNDERDAWG LEGENDS AUTHOR PROGRAM REGISTRATION FORM

UNDERDAWG LEGENDS AUTHOR PROGRAM REGISTRATION FORM
Location: Center for Black Literature & Culture, 40 East Saint Clair Street, Indianapolis, IN

46204 17Dates: May 5 - May 10 Ages: 9-12 Cost: FREE
PARTICIPANT INFORMATION
Childs Full Name
Age
Grade Level
School Name
PARENT/GUARDIAN INFORMATION
ParentGuardian Name
Phone Number
Email Address
example@example.com
Emergency Contact Name Number
PROGRAM DETAILS
Why does your child want to join this program Optional but encouraged
CONSENT & AGREEMENT
By signing below, I grant permission for my child to participate in the Underdawg Legends Author Program. I understand that this is a free program and that my child is expected to attend all sessions. I also give permission for my child's photo or written work to be used for program promotion.
ParentGuardian Signature

Clear
Date

MonthDayYear
Date
To Register: Email the completed form to UNDERDAWGTALKLLC@GMAIL.COM or bring it to the Center for Black Literature & Culture.

Let's turn young writers into published authors!
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