WAM Adult Education Student Registration Form

"*" indicates required fields

Hidden

Form Settings

Instructions: Use these fields to configure the form for each season. Update Program Name, Season, etc. Parameters are passed into the form using the https://url.org?param1={value1} & param2={value2} structure.
Hidden
This is a 'Settings' field that is used when submitting the data to Salesforce.
Hidden
This is a 'Settings' field that should be updated for each Season of the GOTM program. This is the Salesforce ID of the Program Named above. It is used when submitting the data to Salesforce.
Hidden
This is a 'Settings' field that should be updated for each Season of the GOTM program. It is used when submitting the data to Salesforce.
Hidden
This is a 'Settings' field that should be updated for each Season of the GOTM program. It is used when submitting the data to Salesforce.
Hidden
This is a 'Settings' field specifying the 'Role' on the Program Enrollment. It is used when submitting the data to Salesforce.
Hidden
This is a 'Settings' field specifying the 'Stage' on the Program Enrollment. It is used when submitting the data to Salesforce.
Hidden
This is a 'Settings' field specifying the 'Application Date' on the Program Enrollment. It is used when submitting the data to Salesforce.
MM slash DD slash YYYY
Hidden
This field is used when/if the Salesforce Contact ID is passed into the form using the {pid} parameter. If present we can submit to Salesforce knowing the specific Contact.

STUDENT REGISTRATION FORM

Student Name*
Do you go by a name other than your legal name?
WAM Class #1*
Which WAM class have you signed up for? If you are registering for multiple classes, please select your first class and then use the following question for your second class.
WAM Class #2

MEDIA RELEASE

WAM Media Release*
As a participant of WAM’s programs, students are often be photographed or recorded, and WAM may use such photographs and/or video for any lawful purpose, including for example such purposes as fund raising, board reports, publicity, illustration, advertising, and web content. Photographs and their use in storytelling in social media play an important role in raising awareness and funding for the WAM mission. Please select an option in signing this form to opt in or opt out of your image being used
Hidden
MM slash DD slash YYYY