Name: Moving the Music Forward (Teens)
Start: 2021-01-27T15:00:00-06:00
End: 2021-01-27T16:00:00-06:00

Participant Name

Participant Email

Participant Phone Number

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

Yes
No

Participant Age

County of Residence

Please explain.

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Phone Number

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

Yes
No

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 (over 18)

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

Moving the Music Forward (Teens)

January 27, 2021 @ 3:00 pm - 4:00 pm CST

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Organizer

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