Workshop Registration 3

Workshop Registration

* Indicates required field

Participant Name *

First

Last

Participant Age *

Participant Grade *

Participant School District *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Email *

Parent/Guardian Phone Number *

Parent/Guardian Relationship *

Emergency Contact Name *

Emergency Contact Phone Number *

Program Confirmation *

I confirm that I am registering the above-named child for the Do You Want to Build a Snowman Workshop which will be held at the Heritage Center in Mount Sinai on Saturday, December 14th from 12-2pm. The cost of the workshop is $25 per child.

Photo Permission *

Yes, I DO give permission for my child's photo to be taken and to be used for marketing, advertising, and/or fundraising purposes, electronically or otherwise. No, I DO NOT give permission for my child's photo to be taken and to be used for marketing, advertising, and/or fundraising purposes, electronically or otherwise.

Please review our workshop policies and procedures. By signing this document below, I acknowledge that I have read, understood, and agree to adhere to the workshop procedures and policies outlined above. I give permission for my child to participate in the workshop and accept the terms as stated. I understand that this registration is not complete until submitted and payment is completed.

Electronic Signature *

Today's Date *

I agree to receiving marketing and promotional materials

Submit

After submitting the above registration form, please complete payment by following the steps below:

Workshop Registration Fee: Do You Want to Build a Snowman 12/14/24

$25.00

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North Shore Youth Council is a 501(c)(3) not-for-profit community-based organization, funded in part by the Town of Brookhaven, the County of Suffolk, the State of New York, the North Shore Consortium, and public and private donations.

Phone: 631-744-0207

Fax: 631-744-3565

P.O. Box 1286, Rocky Point, NY 11778

Main Office Hours: Mon-Fri, 9am to 5pm

Visit us in the portables on the grounds of the
Joseph A. Edgar School in Rocky Point.