Complete this registration form to sign up for in person Play Me a Story.
After clicking submit, you will be asked to select the date you wish to attend and then complete your payment information. Thank you.
Caregiver First name
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Caregiver Last name
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Email
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Phone number
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Student 1 - name
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Student 1 - date of birth
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Student 2 - name
Student 2 - date of birth
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Does your student(s) have any communication, mobility, or other needs that you would like us to know about?
Allow PS to use my childs photo video audio
*
Yes, can use in marketing
No, do not use in marketing
Release
*
I understand these activities may include certain risks including, but in no way limited to: (1) moderate & severe personal injury, (2) property damage, (3) disability, (4) death, & (5) sickness or disease including, without limitation, COVID-19.
Release
*
I specifically release Education, its owners, directors, employees, & volunteers from any claim of any kind arising from my student’s participation in the Education program.
*
= required field