Registration

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Registration

Appalachian Impact

at West Virginia Wesleyan College
Thursdays 3:30 - 5:30
Contact us: julie@appalachianimpact.org

Email *

Student name *

School name *

Grade *

teacher name *

I give permission for my child's teacher to complete a small survey about my child and what academic help or enrichment they may need. *

Yes

Parent/guardian name *

Home address *

Phone number *

Can we text you with important information or updates? *

Yes

I understand that this program is currently only held on Thursdays. *

Yes

Required

Please check all that apply.

My child has permission to take walking field trips during The Adventure.

The Adventure has permission to take videos and/or photos of my child for use on our social media.

Child shirt size *

Youth XS

Youth S

Youth M

Youth L

Youth XL

Adult S

Adult M

Adult L

Submit

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