YWCA Metropolitan Chicago

RSVP for In-Person Youth STEAM Programming - Winter 2021

We still have room for 19 guests at this event.
The reservation limit per user is 1 guests.

Name:

First Required	Last Required

Email: Required

May YWCA Chicago contact you via email outside of this event registration?

Please specify the number of guests, including yourself, that will attend:

Please answer the following additional questions to help us prepare for the event.

Disclaimer: By registering for this event series, you confirm that the youth(s) taking part have parental/guardian permission to do so. Taking part in the activities shown are being done at your own risk and YWCA Metropolitan Chicago staff, board, and volunteers shall not be held liable for any accidents or injuries cause by neglecting to follow directions as described.

*1.

Question - Required - Student First Name

*2.

Question - Required - Student Last Name

*3.

Question - Required - CPS Student ID

*4.

Question - Required - School Name

*5.

Question - Required - Email Address

*6.

Question - Required - Who's email is this?

*7.

Question - Required - Does the student have parent or guardian permission to take part in this virtual event series?

*8.

Question - Required - Home Address Line 1

*9.

Question - Required - Home Address Line 2

*10.

Question - Required - City

*11.

Question - Required - State

*12.

Question - Required - Zip Code

*13.

Question - Required - Student's Birthday

Month

Day

Year

*14.

Question - Required - Student's Age

*15.

Question - Required - Student's Grade

*16.

Question - Required - Gender

*17.

Question - Required - Race or Ethnicity

Parent or Guardian Information

*18.

Question - Required - Phone

*19.

Question - Required - Email

*20.

Question - Required - Emergency Contact

*21.

Question - Required - Relationship to Student

*22.

Question - Required - Phone Number

*23.

Question - Required - Special Needs and Considerations

(Maximum response 255 chars, approx. 5 rows of text)

*24.

Question - Required - Dietary Restrictions

(Maximum response 255 chars, approx. 5 rows of text)

Would you like to receive an email reminder for this event?

Yes, email me a reminder