Test: Children’s Holiday event

2022 Children’s Holiday Drive Thru

Registration Form

Your first child's name(Required)

First Name

Your first child's age(Required)

Your first child's gender(Required)

Non-Binary

Girl

Boy

Your second child's name

First Name

Your second child's age

Your second child's gender

Non-Binary

Girl

Boy

Do you have more than two children?(Required)

Yes

No

How many children do you have?

Your third, fourth, fifth…childrens' first name(s), ages, and gender.

Example: John Doe, Jr., 3, Male Jane Doe, 10, Female Harry Doe, 12, Non-Binary

Parent's / Guardian's Name(Required)

First Name Last Name

Email(Required)

Please contact us at 951-801-5674 videophone, 951-275-5000 voice if you don’t have an email.

Enter Email Confirm Email

Alternative Contact Information

Preferred Contact Method

E-mail

Videophone

Voice

Mailing Address

CAPTCHA

Center On Deafness Inland Empire