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Wilson Club Registration
Thursdays 3:15-4:45pm; Girls Who Code - Spring 2019
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Email
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Your email
Student's full name
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Birthdate
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DD
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Age (Min 6th grade or 11 years old)
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Your answer
Student's email address
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Student's phone number
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Allergies and medical conditions
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Your answer
Guardian 1 full name
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Your answer
Guardian 1 phone number
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Guardian 1 relation
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Father
Mother
Legal Guardian
Power of Attorney
Other
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Guardian 2 full name
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Guardian 2 email address
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Guardian 2 phone number
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Guardian 2 relation
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Father
Mother
Legal Guardian
Power of Attorney
Other
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