Bold Vision Self Esteem Workshop Registration

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Parent / Guardian Name*
First Last
Phone
Email
Participant Information
How Many Will Be Attending?*
Up to 2 children. For more than two resubmit the form
Child's Name*
First Last
Child's Age*
Child's Name*
First Last
Child's Age*
Signature*
By signing your name, you as the Parent/Guardian of the above child(ren), give permission for them to attend the Self Esteem Workshop
Registration Payment Information
Clicking the submit button will redirect you to PayPal to finish your secure payment
Number of Children Attending*
$90 for 1 person $160 for 2 persons
Total
$0.00
Phone
This field is for validation purposes and should be left unchanged.

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Participant Information

Registration Payment Information