First name:
Last name:
Email address:
Mailing address:
Phone numbers:
I am 18 or over
I will participate on the school day Friday?
Do you wish to be assigned to a structure?
Are you willing to be a head of household?
If you have a preference, please list your top three structure preferences.
Others you wish to be included in your household (i.e. children, spouse, other adult participant. Each adult must complete a registration form) Over 18? Over 18? Over 18? Over 18? Over 18? Over 18? Please describe your impression including a brief biography; occupation, if applicable; a description of your household, if applicable; and why your impression is at Henkel Square. If your impression requires any special accomodation, please explain Are there any medical conditions that we need to be aware of? I have read and understand the Henkel Square guidelines as posted on the Henkel Square Event page.

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