Kids in the Kitchen - Class Registration (October 29 - December 17) - Urbandale Community Education

Summer 2019 - Kids in the Kitchen Program

ISU EXTENSION PROGRAM IN PARTNERSHIP WITH URBANDALE COMMUNITY EDUCATION

DATES: Tuesdays, October 29 - December 17

(October 29, November 5, 12, 19, December 3, 10, 17)

TIME: 5:15pm - 6:00pm

LOCATION: Urbandale High School – Room 401

Urbandale High School

7111 Aurora Avenue

Urbandale, IA 50322

DEADLINE TO REGISTER: Tuesday, October 22, 2019

GRADES (entering 2019-20 School Year): K - 5th

COST: FREE

SPOTS AVAILABLE: FULL (Additional registered applicants will be added to the waiting list.)

MIN – 8 Students; MAX – 20 Students

If you have any questions regarding registration, please contact

Josh Jacobs ( josh.jacobs@j-hawks.com); office phone: (515) 457-6946

If you have questions regarding class information, please contact

Demi Johnson at 515-957-5783 or email demij@iastate.edu.

Parent Name: *

Email address *

Cell Phone Number *

Student Name *

Grade *

Gender *

Address

City, State and ZIP Code: *

Emergency Phone Number *

Required in case of Emergency

Emergency Contact Information - Relationship to Student: *

Medical Insurance Provider *

After-Class Dismissal Process: *

Please choose after class dismissal details for your child(ren).

Special Accommodations (if applicable): *

I certify that the above information is correct and that the individual listed above has my permission to participate in this Community Education program. Urbandale Schools, agents and representatives will not be responsible for any injuries, loss of property or any accidents during this program. *

Signature & Date - I certify

There will be a $1.00 convenience fee to submit this online form.

* required field