Change Agents - Kids Potomac Elementary Fall 2022
Change Agents – Kids is designed to educate, inspire and empower children to create positive change. Our programs engage children in awareness activities throughout the school year. Age-appropriate lesson plans include fun and exciting ways to teach about challenges faced by our community and our world. Our goal is to empower our students and ensure they know their actions CAN make an impact.

THIS REGISTRATION IS FOR AN NINE WEEK SESSION
10/4
10/11
10/18
10/25
11/1
11/15
11/29
12/6
12/13
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Email *
Childs Name *
Grade *
Teachers Name *
Parents Name *
Parents Email *
Parent Phone Number *
Emergency Contact Information (Please add name, contact number and relationship) *
Child will be picked up by the following person or people:
Allergies (if yes please explain in comments below) *
Required
I consent to having my child's photograph taken and used on Change Agents social media page or website.
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Comments (please include anything we should be aware of here).  We look forward to getting to know your child!  
Payment of $210 for nine week registration will be made by : *
A copy of your responses will be emailed to the address you provided.
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