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Registration Form for Workshops
Writing Workshop Registration Form Summer 2009
Name: __________________________________________________________________
Address: ________________________________________________________________ Phone: ____________ Date of Birth: ___________ Male or Female
Grade enrolled in for Fall 2009 (must be at least entering 1st grade): _________________
Emergency Contact Information (Other than parent):
Name: __________________________________________________________________ Address: ________________________________________________________________
Phone: ____________ Relation to the applicant: ________________________________
Because we will be offering a snack, it is important that we are aware of any food allergies. Allergies: _______________________________________________________________
Any other Medical Information we should be aware of? (Medications, conditions, etc.)
___________________________________________________________________________
______________________________________________________________________
_______________________________________________________________________
Please check the work shops you would like to attend, you may attend as many or few as you would like, but please be aware that there are limited spaces for each workshop.
___ July 9th Short Stories
___ July 16th Dramatic Reading and Writing
___ July 23rd Poetry
___ July 30th Lyrics
___ August 6th Nonfiction
___ August 13th Short Stories
___ August 20th Dramatic Reading and Writing
___ August 27th Final day – reading and a party!
Parent Information & Consent Name: __________________________________________________________________
Address: ________________________________________________________________ Phone: Home ______________ Work _____________
By signing this I agree to allow (applicant’s name) ________________________ to attend the above marked workshops from 9am to 12pm.
I understand that my child will be in a learning environment and should act accordingly.
I also understand that if there are any behavioral problems, I may be called and asked to pick up my child.
_______________________________ _______ ______________________________
Parent's Signature Date Applicant's Signature
Send form to Emily Thomas by July 1, 2009
50 Edgecomb Street, Albany NY 12209
or fax to 463-5709
Please don't email - I need a signature.
Emz214 |
Latest page update: made by Emz214
, Apr 27 2009, 1:07 PM EDT
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