Animation - Storytelling Registration Form

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This form will register your child for animation classes at Palama! This program is for students, ages 8 – 13, who have some animation experience or previously completed an animation class at Palama Settlement.

Please fill out one form for each child!

When: Mondays from 3 – 5 p.m. (15 classes)
(Aug 23, 30; Sept 13, 20, 27; Oct 4, 18, 25; Nov 1, 8, 15, 22, 29; Dec 6, 13).
No class on Sept 6 (Labor Day) or Oct 11 (Fall Break).

Email *

Participant Information

This section will ask you information about the child you're signing up!

Participant's First Name *

Participant's Last Name *

Participant's Age *

Participant's Gender *

Female

Male

Non-binary

Prefer not to say

Other:

Participant's Grade *

Participant's Birthday *

YYYY

Home Phone Number *

Address *

Zip Code *

School name *

Does the participant have any medical conditions that we should be aware of? (ie. Asthma, Diabetes, seizures, heart problems, food allergy, drug allergies etc) *

Yes

Required

If yes, please provide information, and list any medications being taken.

Physician Name *

Physician Phone Number *

Medical Insurance Carrier *

Policy/Membership Number *

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