2022-2023 Children & Teen Program Registration
Welcome, families! Any comments, questions, concerns or technical issues with this form may be directed to re@uumiami.org. Thank you in advance for registering your child for either Childcare (ages 0-3), Waves & Reefs (Ages 4-11), and/or Activism in Action (12-17).
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Email *
 Parent/Guardian Adult #1 Name: *
Parent/Guardian #1 Email: *
Parent/Guardian #1 Cell Phone Number *
Parent/Guardian #1 Mailing Address: *
Parent/Guardian #1 Preferred Method of Communication *
Required
 (If applicable) Parent/Guardian Adult #2 Name:
 (If applicable) Parent/Guardian #2 Email:
(If applicable) Parent/Guardian #2 Cell Phone Number
Parent/Guardian #2 Preferred Method of Communication
I am/My family is a... *
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