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Repair the World Family Programs
Repair the World Family Programs
I am a parent registering my children and/or spouse for this program
I am an adult supervisor registering a group of children (under 18) for this program
Program Information
Program Name
Event Description
Start Date
Spots Left
Venue Name
Program has shifts?
Yes
No
Select the number of adults being registered
Please select...
1
2
Select the number of children being registered
Please select...
1
2
3
4
ERROR:
Shift
Spots Left
Register
Spots Open?
Yes
Space for family?
ERROR:
Multiple Shifts Selected Error Message
Adult Supervisor Information
Please provide the contact information of the adult supervisor of this group. If you are submitting on behalf of someone else who will be attending as the adult supervisor, provide their contact information below.
First Name
Last Name
Email
Cell Phone
Zip Code (5 Digits)
Registered Particpant
Yes
Additional Participants
You may register up to 8 additional participants.
This participant is an adult
This participant is a child (under 18)
First Name
Last Name
Email
Sharing an email for this participant ensures that everyone registered receives all communication for this program. You may leave this field blank if this participant does not have an email address
Date of Birth (MM/DD/YYYY)
Cell Phone
Zip Code (5 Digits)
Registered Particpant
Yes
Error
Error Message - No Children Registered
Adult 1 Info
First Name
Last Name
Email
Cell Phone
Zip Code (5 Digits)
Registered Particpant
Yes
Adult 2 Info
First Name
Last Name
Email
Sharing an email for this participant ensures that everyone registered receives all communication for this program. Leave the field blank if you do not have this participant's unique email address
Cell Phone
Zip Code (5 Digits)
Registered Particpant
Yes
Child 1 Info
First Name
Last Name
Email
Sharing an email for this participant ensures that everyone registered receives all communication for this program. You may leave this field blank if this participant does not have an email address
Date of Birth (MM/DD/YYYY)
Registered Particpant
Yes
Child 2 Info
First Name
Last Name
Email
Sharing an email for this participant ensures that everyone registered receives all communication for this program. You may leave this field blank if this participant does not have an email address
Date of Birth (MM/DD/YYYY)
Registered Particpant
Yes
Child 3 Info
First Name
Last Name
Email
Sharing an email for this participant ensures that everyone registered receives all communication for this program. You may leave this field blank if this participant does not have an email address
Date of Birth (MM/DD/YYYY)
Registered Particpant
Yes
Child 4 Info
First Name
Last Name
Email
Sharing an email for this participant ensures that everyone registered receives all communication for this program. You may leave this field blank if this participant does not have an email address
Date of Birth (MM/DD/YYYY)
Registered Participant
Yes
I indicate that I have read, understood, and agreed to the
Release and Waiver of Liability and COVID-19 Waiver
on behalf of all registrants listed in this form.
It may take a some time for this form to process after you click Submit.
Please do not click Submit more than once.
Hidden Fields
# of People Registered
Registered Shift
Spots in Registered Shift
Children Registered
Program Zoom Link
Program Time Zone
Virtual?
Yes
Context
MLK
Alternative Break
Cocktails with a Conscience
Edu Crew
Expansion
Family Engagement
Farm Crew
Fundraising
Giving Circle
Peer Corps
Turn the Tables
Art/Gallery
Film Screening
Teens
VolunTeams
Contact Information