Digital Pull-Up Registration Form
Date
Full Name
Email
Phone
Please fill out the following below if your
child(ren) are participating.
Child(ren) 1 Full Name
Child(ren) 1 Age
Child(ren) 2 Full Name
Child(ren) 2 Age
Additional Child(ren) Name/Age
Relationship to Child(ren)
What is your level of computer experience?
None
Basic
Med-Level
Experience
For all Adults, please answer the following questions for our grant
Employed
Self-Employed
Retired
Unemployed
Hourly Wages
Under $16 per hour
$16 - $20 per hour
Over $20 per hour
Register
