Student Workshop Registration Form

Course Details

Course Name

Course Code

Course Description

Student Details

First Name

Last Name

Birth Date

Gender

Grade

Parent/Guardian Details

First Name

Last Name

Address line 1

Address line 2

City/Town

State/Province

Postal/Zip Code

Mobile Phone

Agreement and Signature

I hereby certify that the foregoing information is true and correct to the best of my knowledge. I further consent to my child's participation in the program.

Parent/Guardian Signature

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