School Registration Form

School Registration Form

Complete this form in order to register your students for the November 14 celebration with Ruby Bridges. The program begins at 11:00 a.m. at White Concert Hall, Topeka. Note: All forms will be time and date stamped upon receipt. Tickets are first come, first served and limited to the first 1000 registrations. You will receive an email letting you know the status of your registration within 5-7 days of submission.
Your Name*
Email*
example@example.com
Phone Number*
What is the name of the school you are registering?*
Which school district?*
How many students will you be bringing? *
Maximum: 50 Students
Please let us know the grades of the students attending.*

High SchoolMiddle SchoolElementary School (Third Grade and Above)
How many adult chaperones will be attending with your group?*
Confirmation & Signature
Please sign below to affirm that you have fully reviewed and will adhere to the following policies:

I understand that every accommodation is being made to provide a rewarding experience for our students, and that changes to the venue, program, gift bags and any other element are possible.

I understand that our school and school district are solely responsible for the transportation and special needs of the students we bring to this event.

I agree to hold harmless any entity or partner for any unforseen circumstances that may arise and result in a change to the anticipated program.

Note: The use of any recording devices during the event, including but not limited to, cell phones, video cameras, or digital recorders, is not permitted during Ms. Bridges’s speaking engagement.

All forms will be time and date stamped upon receipt. Tickets are first come, first served and limited to the first 1000 registrations. You will receive an email letting you know the status of your registration within 5-7 days of submission.
Full Name*

First NameLast Name
Sign using your touchpad, mouse, finger or stylus.*

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School Registration Form

Confirmation & Signature