Registering Adult Information

First Name:

Last Name:

Role:

Address:

Telephone:

Email:

Additional Information

Child's Name:

Child's School:

Child's Grade:

Parent's Name:

Parent's Address:

Parent's Telephone:

Emergency Contact Name:

Emergency Contact Telephone:

Photo Release:

I have checked with my little´s parent to make sure it is OK for the child to be photographed at the event.

Name of Additional Adult Attending Workshop
First Name:     Last Name:
Session Date: October 27, 2012

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