Name: Bring Song Ideas to Life (Teens)
Start: 2021-01-12T15:00:00-06:00
End: 2021-01-12T16:00:00-06:00

Participant Name

Participant Phone Number

Participant Email

Would you like to add this email to the Southern Word email list to receive updates about upcoming events and workshops?

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Participant Age

County of Residence

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Parent/Guardian Name

Parent/Guardian Email

Would you like to add this email to the Southern Word email list to receive updates about upcoming events and workshops?

Yes
No

Parent/Guardian Phone Number

Parental Acknowledgement (Required for Youth Under 18): I understand that by enrolling my child in this online workshop, I am granting Southern Word and it's mentors to engage in an online learning experience.

Yes
No
Not Applicable (18 or over)

Participant Acknowledgement: I understand that this registration is for a weekly workshop series running from January 11, 2021 through March 12, 2021. I plan to attend all workshops and will let the workshop leader know if I will be unable to attend any week.

Yes
No

Where would you like communications for the workshop to be sent?

Parent/Guardian Email and/or Phone
Participant Email and/or Phone
Both

Bring Song Ideas to Life (Teens)

January 12, 2021 @ 3:00 pm - 4:00 pm CST

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