JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Workshop Registration: Student Information
Please take note of age restrictions before signing students up for workshops, and remember that each student is restricted to participating in TWO workshops per season.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Workshop 1
*
Choose
Science of Me, Session TWO (ages 8-13)
Science of Me, Session THREE (ages 8-13)
Wild Writing: Describing Nature’s Beauty & Mystery (ages 9-11)
I Am A Camera (ages 10-13)
Writing for Laughs (ages 11-14)
Workshop 2
Choose
Science of Me, Session TWO (ages 8-13)
Science of Me, Session THREE (ages 8-13)
Wild Writing: Describing Nature’s Beauty & Mystery (ages 9-11)
I Am A Camera (ages 10-13)
Writing for Laughs (ages 11-14)
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Grade
*
Choose
3
4
5
6
7
8
9
10
11
12
Date of Birth (please make sure to select the correct year!)
*
MM
/
DD
/
YYYY
School
*
Your answer
Type of School
*
Choose
Public
Charter
Independent
Private
Homeschool
Other
Does your student qualify for Free or Reduced Price Lunch?
*
Yes
No
Don't Know
Does your student have permission to walk home by themself?
*
Yes
No
The following people are authorized to pick up this student:
Your answer
Student's Email (Optional)
Your answer
Student's Cell Phone Number (Optional)
Your answer
Is your student enrolled in an English Language Learner program (ELL/ESL)?
*
Yes
No
If yes, what level has your student been assigned? (Please refer to your latest report card)
Your answer
Does your student have any special needs (e.g. learning, physical or mental health)?
*
Yes
No
If yes, please explain:
Your answer
Does your student have an Individualized Learning Plan (IEP)?
*
Yes
No
If yes, please explain:
Your answer
I give 826 Valencia permission to communicate these needs to volunteers in order to support their work with my student.
Yes
No
Clear selection
Student's First Language(s)
*
Your answer
Language(s) Spoken at Home
*
Your answer
Race/Ethnicity
*
Choose
American Indian/Native American or Alaska Native
Asian, Asian Indian, Hawaii Native or Pacific Islander
Black or African American
Hawaii Native or Pacific Islander
Hispanic/Latinx
White or European American
More than one race
Prefer Not to Say
Other
Next
Page 1 of 7
Clear form
Never submit passwords through Google Forms.
This form was created inside of 826 Valencia.
Report Abuse
Forms
