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ADA's Project Power Online Enrollment Form (May/June series)
Thank you for filling out this form to enroll your child in ADA's Project Power-Virtual Series. We are so excited for your child and family to join in. Please let know if have any questions by reaching Arti at
diyaholisticlifecare@gmail.com
. Thank-you!
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* Indicates required question
Email
*
Your email
Adult Name
*
Your answer
Child's Name
*
Your answer
Child's Age
*
Your answer
Address
*
Your answer
Phone number
*
Your answer
Emergency Contact Name and Number
*
Your answer
I consent to my child possibly being featured online, the American Diabetes Association (ADA page)
*
Yes
No
I consent to allowing my child participate in the Project Power for this session
*
Yes
No
T-shirt size (Youth S; Youth M, Youth L, Youth XL)
*
Your answer
Sessions are twice a week for 1 hr online (Zoom format). Please sign up for one 6-week session
*
Tuesday, May 3rd- Thursday May 19th (7-8pm EST; 6-7pm MST; 4-5pm PST)
Tuesday, May 24th- Thursday, June 9th (7-8pm EST; 6-7pm MST; 4-5pm PST)
Tuesday, June 14th- Thursday, June 16th (7-8pm EST; 6-7pm MST; 4-5pm PST)
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