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Student Information

Student's Gender Pronouns *
(check any that apply to your identity)
During summer, this refers to the grade student will be entering.

Parent/Guardian 1 Information

Is Parent/Guardian 1 the student's primary residence? *
Please provide an email you use regularly.

Parent 2 Information

Is Parent/Guardian 2 the student's primary residence?

Emergency Information

In the event of emergency, Parents/Guardians will be contacted FIRST. Please provide a NON-Parent/Guardian Emergency Contact
In the event of emergency, Parents/Guardians will be contacted FIRST. Please provide a NON-Parent/Guardian Emergency Contact
Emergency Care Authorization *
In the event of serious accident or injury, every effort will be made to contact a parent or guardian. Because I understand that a situation could arise when first aid and/or emergency treatment may be necessary and I cannot be reached, I hereby authorize Read and Write Kalamazoo personnel to make provisions for treatment with the appropriate medical personnel or facility. I also understand that in the event my student (who is under the age of 18) needs to be taken to an emergency room, they will be taken to Bronson via ambulance (as Borgess does not provide pediatric emergency services).
Typing your name here is a digital signature confirming your response to the above Emergency Care Authorization

Other Information

Please inform us of any allergies or health concerns (including any and all medications) which may be pertinent to our time with your student. If student will have medication with them (inhalers, EpiPens, etc.), a form must be completed onsite.
RAWK involves working in large and small groups, one-on-one interactions, giving and receiving feedback, reading aloud, and active listening. Please provide us with any special information you feel would help us create a safe and supportive environment for your student.
Media Release *
I permit Read and Write Kalamazoo to take photographs, audio, and video recording of my student for the explicit purpose of chronicling, promoting, and celebrating the RAWK program. I understand that any media taken of my student taken during RAWK programming will not be used by anyone not affiliated with Read and Write Kalamazoo.
Reserve My Spot *
There are a limited number of spots available in each workshop. By completing this registration a spot will be reserved. If the workshop is already full, this registration will place you on the Wait List.
How did you hear about this workshop?

Data Collection & Reporting

We strive to serve our diverse community. Please share more about your family to help us assess and improve our community connection as well as report information anonymously to funders. This information will be kept completely confidential.
Does Household qualify for Free or Reduced Lunch?