REGISTER A TEEN FOR OUR PROGRAM

Makerie Workshop Teen Afterschool Application

This is where you register your teen(s) with our program. You'll sign up for individual days and times after you complete this step.

This form MUST be filled out by a custodial parent or legal guardian.
A separate application must be completed for each teen you want to register.

If you have any questions, please contact us at 352-363-5399 or via email.

Your teen's FULL LEGAL name

Your teen's PREFERRED name

Your teen's gender identity

Your teen's pronouns:

Your teen's date of birth

Month

Day

Year

Your teen's grade for the 2025-2026 school year

These next questions are all about YOU - the custodial parent or legal guardian.

Your full name

Your relationship to the teen (e.g., "Father")

Your home address *

Multi-line address

Country/Region

Address

City

Zip / Postal code

Your email address

Your phone number

OPTIONAL: Alternate phone numbers for you (e.g., your work number) in case we can't reach you at the number you entered above:

OPTIONAL: Alternate phone numbers for you (e.g., your work number) in case we can't reach you at the number you entered above:

Name

Phone number:

Name:

Phone number:

AUTHORIZED PICK-UP PERSONS: Please provide the full names of each person other than you that you want to be able to check your child out at the end of the day. We won't release your teen to anyone other than you or these people

PHOTO / VIDEO RELEASE: I give permission for my minor child to be photographed &/or videotaped during the Makerie Workshop (Master Builder Camp, LLC) programming. I understand the photos/videos will be used to keep a visual journal of activities for participating families to view at home as well as for promotional purposes for Makerie Workshop (Master Builder Camp, LLC) including printed materials and on the internet. I understand that although my child's photograph/film footage may be used for advertising, their identity will not be disclosed, I understand that there is no compensation for use of these photos/videos and understand that all photos/videos are the property of Makerie Workshop (Master Builder Camp, LLC) and its affiliates.

Do you consent to these video / image release terms? (Consent is NOT required!)

Yes

That's it! A Participation Waiver will arrive in your inbox after your application is reviewed. Now we just need your signature

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