Writing Project : Youth Writing Festival

Youth Writing Festival

Saturday, September 30th 10am - 2pm

Parent Information

Please make sure you have filled in all required fields with valid information.

Parent First Name:

Parent Last Name:

Home Phone:

- Phone (next 3 digits): - Phone (next 4 digits):

Email:

Home Address:

City:

State:

Zip Code:

How did you hear about our program?

I authorize emergency care through 911 number and University Health Center for WCU Programs:

Yes No

I give WCWP permission to use photos and video of my children for publicity:

Yes No

I understand that this event is designed for students who enjoy writing and reading and that it is not a remedial program:

Yes No

Emergency Contact Information

Please make sure you have filled in all required fields with valid information.

Emergency Contact Name 1:

Emergency Contact Number 1:

- Phone (next 3 digits): - Phone (next 4 digits):

Emergency Contact Name 2:

Emergency Contact Number 2:

- Phone (next 3 digits): - Phone (next 4 digits):

Child Information

Please make sure you have filled in all required fields with valid information.

Child First Name:

Child Last Name:

Date of Birth:

Current School:

School District or Town of Private School:

Medical problems and allergies our staff should know about:

Total Cost: $45