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Programs
After-School Programs
Summer Camp
Annual High School Writing Contest
Community Collaborations
About Us
Our Impact
Our Story
Our Team
Get Involved
Writing Gallery
Donate
donate now
Programs
After-School Programs
Summer Camp
Annual High School Writing Contest
Community Collaborations
About Us
Our Impact
Our Story
Our Team
Get Involved
Writing Gallery
Donate
Programs
After-School Programs
Summer Camp
Annual High School Writing Contest
Community Collaborations
About Us
Our Impact
Our Story
Our Team
Get Involved
Writing Gallery
Donate
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FORM: Virtual Young Writers Society [Fall 2020]
Student Information
-
Step
1
of 3
Student Name
*
First
Last
Requested program day
*
(Waitlist only) MONDAY: 4th & 5th graders (3:30-4:30)
MONDAY: Middle Schoolers (4:30-5:30)
(Waitlist only) WEDNESDAY: 4th & 5th graders (3:30-4:30)
WEDNESDAY: Middle Schoolers (4:30-5:30)
Gender
*
Female
Male
Other/Prefer not to answer
Date of Birth
*
(MM/DD/YY)
Ethnicity/Race
*
American Indian/Alaskan Native
Asian
African American/Black
Hispanic/Latino
Caucasian/White
Native Hawaiian/Pacific Islander
Multi-Racial (no single race applies)
Special Needs
Grade for 2020/2021 school year
*
4th grade
5th grade
6th grade
7th grade
8th grade
School for 2020/2021 school year
*
Do you participate in any of our partner programs? Check all that apply.
TGI (The Greatest Investment)
Boys & Girls Clubs
Young Life
PKZ (Parramore Kidz Zone)
Next
Parent or Guardian Name
*
First
Last
Parent/guardian PRIMARY phone number
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
Next
PHOTO RELEASE STATEMENT
I agree to allow my child to participate in all Page 15 programs and activities and to appear in person or in voice, video or photographic presentation for radio, television, website or print media reports and/or media campaign(s) resulting from participation in a Page 15 program and/or event.
PARTICIPATION AGREEMENT
*
I certify that I am the legal Parent/Guardian of the child(ren) registering and agree that I will not hold Urban Think Foundation (dba Page 15) or its representatives responsible for any injuries which may be incurred by my child in any or all activities at the program for which we are enrolling. I understand that University of Central Florida, Urban Think Foundation (dba Page 15) reserve the right to limit participation of any child for disciplinary reasons or non-payment of fees. My child is required to abide by the policies and procedures of the Urban Think Foundation and Page 15 staff.
Name
SUBMIT REGISTRATION