Register for dzanc house youth programs Prior to registering for one of our youth programs, please review the “About Our Youth Programs” page. Fill out the form below to register. Register early, spots fill up quickly! Program of Interest * Roots & Wings - Elementary School Workshops EmpowerED - High School Workshops Student's Name * First Name Last Name Student's Age * Student's grade (entering grade in Fall 2024) * Student's School Name * Student’s Allergies to medicines/food (include if airborne, etc.) * Reaction to Allergen * Parent / Guardian's Name * First Name Last Name Parent / Guardian's Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent / Guardian's Phone * (###) ### #### Parent / Guardian's Email * Emergency Contact's Name * First Name Last Name Emergency Contact's Relationship to Student * Emergency Contact's Phone * (###) ### #### Emergency Contact's Email * Which workshop session are you interested in? * Fall, October 13-November 10 2024 Winter, January 5-February 2 2025 Spring, April 6-May 4 2025 Summer 2025, July 6-July 27 2025 Thank you for signing up for one of the Dzanc House youth programs! You'll hear from us shortly.
