Esperanza Workshop Registration Form

Student(s) Names

Email

Student's Date of Birth

Notes about student(s)

Parent/ Guardian Name

Contact Phone Number

Student(s) T-shirt Size

Please choose from: Youth Small, Youth Medium, Youth Large, Adult Small, Adult Medium, Adult Large, and Adult XLarge

Please list any known allergies your student(s) have

If any other physical conditions, please explain

Please list all medications your student(s) are taking

Alternative Contact Name

Alternative Contact Phone Number

Alternative Contact Relationship

Summer Arts Workshop Registration Form