Project Power Registration Form 2021
If you are interested in registering your child for a fun, interactive virtual class centered around healthy eating and physical activity, please complete this form. All participants will participate in a hour-long virtual class twice a week, and receive a gift basket and journal! The program is FREE for all participants.

November 2 - 18 2021
Tuesdays and Thursdays at 6pm

If you have any questions, check out the website at: https://www.diabetes.org/community/project-power
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Student Information
Please complete this section with information about your child.
Student's Name: *
Student's Birthday: *
MM
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DD
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YYYY
Student's Gender: *
Student's T-Shirt Size: *
Student's Address: *
Parent/Guardian Information
Please complete this section with information about yourself.
Parent/Guardian Name: *
Parent/Guardian Phone Number: *
Parent/Guardian Email Address: *
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