Kúkátónón Troupe Member Registration 2018/2019 Performance Season Open Enrollment

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for filling out this Troupe member registration form, and be sure to fill out one per child. This form is mandatory for children to participate in Kúkátónón.

We accept cash or checks for registration fees (please make checks payable to: Kúkátónón). If you have questions, please contact Ms. Trina at busops@kukatonon.org or (503) 756-5312. Thank you!

Email *

Option 1

Clear selection

TROUPE MEMBER INFORMATION

Please answer the following questions with information about your child. A section for parent/guardian information will follow.

Member First Name *

Member Last Name *

Member Phone Number (if different from parent) *

Example: 503-123-4567

Member Date of Birth *

YYYY

Member Age *

What School does Member attend? *

Member's Grade at School *

Member Gender *

Medical Information

Please check all that apply and provide a description below.

My child has allergies

My child takes medication that Kukatonon should be aware of

My child has other medical concerns that Kukatonon should be aware of

Other:

Please indicate your child's race and ethnicity (used for grant reporting purposes) *

African American

African

White

Asian

American Indian/Alaska Native

Native Hawaiian or other Pacific Islander

Latino or Hispanic or Spanish Origin

Two or more ethnicities (IF YOU CHECK THIS BOX, PLEASE ELABORATE BELOW, THANKS!)

Other:

If you answered "Two or more ethnicities" above, please let us know with which ethnicities you identify

Is your child eligible for Free or Reduced price lunch at school? *

Free

Reduced

Not Eligible

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms