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Thank you for your interest in signing your child up for our program. Please complete a registration form and our staff will contact you soon to confirm your registration:

Virtual program - youth registration form

Youth Registration Short Form for VIRTUAL Programs

* Indicates required field

Guardian Name *

First

Last

Email *

Phone Number *

Youth #1 *

First

Last

Youth #1 Date of Birth *

Youth #2 *

First

Last

Youth #2 Date of Birth *

List any additional youth with their dates of birth: *

I understand VWS may wish to publish photographs of or by, information about, artwork, written work, and / or statements by parents/ participants through various media forms to showcase programs and activities and provide an opportunity to learn more about VWS. I give VWS permission to publish my, and my child's name, image, written work and / or artwork free of charge for such purposes. *

Yes No

By entering your name below you acknowledge that you have read and understand the above and have indicated your choice for all individuals on this form. *

First

Last

[object Object]

Email Opt In - Do you want to be added to our mailing list and receive interesting, timely information about our programs, events, and outcomes? *

Yes, add me or I'm already on the list No thank you

Voluntary Demographic Survey (assists our programs with cultural relevancy and funding)

Participant race and/or ethnicity *

Asian Black Latinx Indigenous White Prefer not to state Fill in below

Space for those who prefer to fill in: *

Does child qualify for free/ reduced school meals? *

Yes No I don't no / I prefer not to state

Submit

Programa Virtual - Registracion para jovenes

Registracion para jovenes - programas virtual

* Indicates required field

Nombre del Padre de Familia, Guardian *

First

Last

[object Object]

Correo Electrónico *

Número de teléfono *

Joven #1 *

First

Last

Joven #1 fecha de nacimiento *

Joven #2 *

First

Last

Joven #2 fecha de nacimiento *

Escribe joven adicional con fecha de nacimiento *

Entiendo que VWS puede publicar fotografías de o por información sobre obras de arte, trabajos escritos y / o declaraciones de padres / participantes a través de varios medios para mostrar programas y actividades y brindar la oportunidad de aprender más sobre VWS. Doy permiso a VWS para publicar mi nombre y el de mi hijo, imagen, trabajo escrito y / u obras de arte de forma gratuita para tales fines. *

Si No

La Firma *

First

Last

[object Object]

Quieren recebir correo electrónico por informacion de otras programas para jovenes? *

Si No

Encuesta demográfica (ayuda con la financiación, ¡gracias!).

Raza / Etnicidad *

Asian Black Latinx Indigenous White Prefiero no decir Rellenar abajo

Rellenar si prefieres: *

¿El niño califica para comidas escolares gratis / reducidas? *

Si No se No Prefiero no decir

Submit

ventana wildlife society

9699 Blue Larkspur Ln, Ste 105
Monterey, CA 93940
(831) 455-9514 fax (831) 455-2846

Fill Out to Complete Registration

Youth Registration Short Form for VIRTUAL Programs

Registracion para jovenes - programas virtual

ventana wildlife society

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