Register | Repair The World

I am a parent registering my children and/or spouse for this programI 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?

YesNo

Select the number of adults being registered

Select the number of children being registered

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

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

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

Cell Phone

Zip Code (5 Digits)

Registered Particpant

Yes

Adult 2 Info

First Name

Last Name

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

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

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

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

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.

Repair the World Family Programs