Year 5 - 7 Poetry Workshop Registration

Years 5 - 7 - Poetry Workshop

"*" indicates required fields

Name*

First Last

Email*

Phone*

Home Address*

Child 1*

First Last

Child 1: Date of Birth*

Child 1: Medical Conditions/allergies

Child 1: A little bit about your child & any concerns to note

Child 2

First Last

Child 2: Date of Birth

Child 2: Medical Conditions/allergies

Child 2: A little bit about your child & any concerns to note

Contact Name*

Contact Number*

Relationship to Child*

What future educational workshops/services might you be interested?