Individual Registration

Please enter information in the form below to process registration for the Fall 2023 Family Workshops: Alcohol & Youth.

Language Preference *

Full Name of Parent *

Email *

Confirm Email *

Phone Number *

Zip Code *

Number of Adults Attending Workshop *

Number of Students Attending Workshop *

Name of Student *

Student Age *

Ethnicity of Student *

Ethnicity of Parent *

Grade Level of Student *

School District Attended *

Obtain and Release Agreement *

YES

Photography and Video Consent Form *

YES

Captcha*