Children’s Assembly registration (RTTC 2024)
Hello! We're excited to have your young people  join us at Abundant Beginnings' Children’s Assembly alongside Right to the City! 

Please fill out this form to tell us a bit more about them. 

If you have more than one child, please fill out one form per child.

Please text Shayna Cureton at 510-612-2283 with any questions about the program or if you want to check in about how we can support your child
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Your name  *
What are your pronouns? *
Email? *
Phone number? *

How do your kids refer to you?

 *
What is your child's name?  *
What is your child's birthday? *
MM
/
DD
/
YYYY
Child’s pronouns? *
Is your child in regular care/school 

Who is authorized to pickup your child from programming?

 *

Offsite Emergency contact: name and phone number 

 *
What days will your child be with us? 
What are your child's identities (i.e. Black, Queer, etc.) *

Will your child be napping?

 *

Does your child wear diapers?

 *

What support needs does your child/family have?

*

Can your child go with us on a walking field trip? (i.e. to a playground nearby)

 *
Do you consent to your child's photo being shared (social media, etc.) ? Names will not be shared. *
If you do not consent, are you ok with their photo being shared with an emoji over their face/back of the head photos? *
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