The Epidemic of Loneliness Among Our Children Registration Name Phone Number Email Address Is there anything particular you would like addressed? How did you hear about this workshop? Do you need childcare? Do you need childcare? Yes No Please provide the name(s) and age(s) of child(ren) needing childcare Would you like to be added to our email list in order to receive info about future classes/workshops? Would you like to be added to our email list in order to receive info about future classes/workshops? Yes No 11 + 1 = Submit