EmailMe Form - 2015-2016 Windows On Waldorf registration

Name *

First Last

Name (if 2nd adult will be attending)

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Email *

Phone *

### - ### - ####

Windows on Waldorf Attending *

Saturday, January 16, 2016 10 a.m. - noon

I cannot attend but would like more information about...(please specify)

I am a *

Prospective Parent

Current CWS Parent

Educator

Other (please specify)

Interested In *

Parent-Child program

Early Childhood (ages 3-6)

Lower Grades (1-5)

Middle School (6-8)

This information helps us best plan your program day

Name of 1st child *

First Last

Age *

Current school (if applicable)

Name of 2nd child (if applicable)

First Last

Age

Current school (if applicable)

Name of 3rd child (if applicable)

First Last

Age

Current school (if applicable)

Referral *