Teen Empowerment Workshop Registration Form

We are so excited that you would like to register your teen for our Teen Empowerment Workshop. Parents/Guardians kindly provide your name, email address, and select the box below to provide your consent. You may reach out with any questions and we will provide additional information. Have an amazing day!

Glom Initiatives Inc.

Parent/Guardian Name

Parent/Guardian Email Address

First Student's Name

Second Student's Name

Third Student's Name

Select Specific Workshop Registration (check all that apply) and Provide Parental Consent Below Select Specific Workshop Registration (check all that apply) and Provide Parental Consent Below April 14, 2023 May 12, 2023 June 9, 2023

Message

I provide consent for my teen to attend the Teen Empowerment Workshop I provide consent for my teen to attend the Teen Empowerment Workshop I provide consent for my teen to attend the Teen Empowerment Workshop