I AM Registration Form

I AM is a program that is built on Love, Peace and Community. Love for who I AM, who I was and who I AM becoming. For Inner Peace I water in order to grow. For the Community of young ladies that have a voice inside, that's ready to stand up for who they are, and not ashamed of their past, nor present, but ready to grow in their full potential.

~Mama Keke
Student Registration Form

Fill out the form carefully for registration
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail (if applicable)
example@example.com
Student Number (if applicable)
Parent/Guardian (if student is under age 18 years of age)

First NameLast Name
Parent/Guardian Email (if student is under 18 years of age)
Paren/Guardian Number (if student is under 18 years of age)
Any Known Allergies
If Yes Please Explain
Describe You or Your Child In A Few Words*
If filling out for self, describe yourself in a few words
"It Takes A Village"

Donations

USDAll donations are used for I AM. Donations are $25 monthly or $7 each class. Your card information is not kept on file by I AM. You will not be automatically charged monthly or weekly. A reminder text or email will be sent to you directly. Donations can also be made via Cash-app, Venmo, Zelle, or Cash *ask for details

Credit Card

Should be Empty:

Student Registration Form

Credit Card