Student Registration Form
Fill out the form carefully for registration
Student Name
*
First Name
Last Name
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian E-mail
*
Parent/Guardian Mobile Number
*
-
Area Code
Phone Number
Parent/Guardian II Name
First Name
Last Name
Parent/Guardian II E-mail
example@example.com
Parent/Guardian II Mobile Number
-
Area Code
Phone Number
Student Grade Level
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Student Teacher Name
*
Is student in KidsZone?
Yes
No
Does the student have food allergies?
*
Yes
No
If yes, please explain food allergies
Is your student one of the following?
Vegetarian
Vegan
Does student have medical concerns?
*
Yes
No
If yes, please explain medical concerns in detail
Please select the DIG IT session(s) for which you are registering:
*
Homesteading for Kids TUESDAYS
Additional Comments
Payment: My Products
*
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( X )
Homesteading for Kids- TUESDAYS
$
76.00
Total
$
0.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Date
Postal Code
Submit
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