Register for Youth Programs

Prior to registering for one of our youth programs, please review our “Overview” page. Fill out the form below to register. Register early, spots fill up quickly!

Program of Interest

Roots & Wings - Elementary School Workshops

EmpowerED - Middle & High School Workshops

Student's Name

First Name

Last Name

Student's Age

Student's Grade (entering grade in Fall 2024)

Student's School Name

Student’s Allergies to medicines/food (include if airborne, etc.)

Reaction to Allergen

Parent / Guardian's Name

First Name

Last Name

Parent / Guardian's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent / Guardian's Phone

(###)

###

####

Parent / Guardian's Email

How did you hear about us?

Emergency Contact's Name

First Name

Last Name

Emergency Contact's Relationship to Student

Emergency Contact's Phone

(###)

###

####

Emergency Contact's Email

Which workshop session are you interested in?