Beauty, Body, and Brains: Children's Wellness Workshop

Beauty, Body, and Brains: Children's Wellness Workshop

Registration Form
Child's Information
Full Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Gender
Grade
Parent/Guardian Information
Full Name

First NameLast Name
Relationship to Child
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Emergency Contact Information
Emergency Contact Name

First NameLast Name
Relationship to Child
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Medical Information
Does your child have any allergies?
If yes, please list:
Does your child take any medication?
If yes, please specify:
Any other medical conditions we should be aware of:
Photo/Video Consent
Workshop Consent
I, blanks give permission for my child, blank , to participate in the Children's Wellness Workshop. I acknowledge that I have provided accurate and complete information regarding my child's medical needs and emergency contacts. I understand that all efforts will be made to ensure a safe environment, and I release the organizers from any liability related to accidental injury.
Parent/Guardian's Signature
Date Signed

MonthDayYear
Date
Should be Empty:

Child's Information