Building Bricks Creator Club- Sterling

Come build with us and express your creativity through fun building challenges. Please fill out a separate registration for each child.

The university plans to capture photographs and video of this event. Be aware that if you attend, you are consenting to the possibility that your image and likeness may be shared or published by the university for marketing-communications purposes. Please notify staff when checking in or alert the photographer if you don’t want your photograph taken.

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Contact Information

First Name

Last Name

Street Address

Street Address 2

City

State

ZIP

Daytime Phone

Evening Phone

E-mail Address

Ages 8-12 (1:30-2:30 PM) ($20.00)

Ages 5-7 (3-4 PM) ($20.00)

Participant's Name

Age

Does the participant have any allergies?

Please list an emergency contact and phone number

Is the participant a current 4-H'er? 4-H membership not required for participation

Yes

Civil Rights Compliance - Participant Info

As part of our commitment to providing equal opportunities in our programming, University of Illinois Extension is required to collect and report overall statistics about the race, ethnicity, and gender of program participants. Your responses are voluntary and appreciated.

Gender

Ethnicity

Race

Total Registration Cost $