Creative Writing Workshops for Kids!

Presented by Children’s Author

Bernae Okegbenro and Enrichment Reading

Learn how to create a memorable character, develop a storyline and

recognize the different character types presented in best selling movies
and literature. Discover the behind the scenes look at becoming an author
as Bernae shares examples from her own books and never before seen
rough draft copies!

Class Schedule

Saturday, February 27th 11:00am-3pm

Grade Level: 2nd – 5th
Location: Atlanta-Buckhead Library
260 Buckhead Ave NE
Atlanta, GA 30305

Friday March 5th 4:30-8:30pm

Grade Level: 2nd – 5th
Location: Hobby Lobby
3001 Chapel Hill Rd
Douglasville, GA 30135

Saturday, March 20th 11:00am-3pm

Grade Level: 2nd – 5th
Location: Villa Rica Library
(Villa Rica Branch)
70 Horace Luther Drive
Villa Rica, GA 30180

Cost per workshop: $50

Lunch or Dinner Provided
Seating is limited
 Registration Form
Child’s Name:_______________________________________________

Date of Birth:____________________ Grade: _________ Age:_______

Parent/Guardian: ____________________________________________

Address: __________________________________________________

Phone: ________________________ Cell: _______________________

Email: ____________________________________________________

I am registering for (circle): Feb 27th March 5th March 20th

HEALTH HISTORY OF CHILD: This is kept confidential.

Attach additional sheet if necessary
Please list any allergies: _______________________________________
_________________________________________________________
Describe your child’s allergic reaction: ____________________________
_________________________________________________________
Other medical concerns: ______________________________________
_________________________________________________________
Medications being used: _______________________________________
_________________________________________________________
Please note that Enrichment Reading Publishing Staff cannot dispense any medications. Do not send any
medications to class with your child.
Does your child wear: glasses ( ) contact lenses ( ) hearing aid ( ) corrective
shoes ( ) prosthesis ( )?
Any other info concerning your child’s health that we should be aware of:
_________________________________________________________

Emergency Contact Information:

Name:________________________ Relationship: __________________
Phone: ____________________________________________________

In the event that neither I nor my designee cannot be contacted at the time of a
medical emergency, I consent to emergency treatment determined necessary by a
qualified physician.

Preferred Medical Facility _____________________________ (optional)

Parent/Guardian Signature: _____________________ Date: __________
Authorization and Consent
As parent, legal guardian or agency representing the child named above, I hereby give consent to enroll my child in
the specified program(s) operated by Enrichment Reading Staff. I recognize that my child must follow safety
instructions, remain in areas designated by staff, and refrain from behavior that is harmful to him/her or others.
Failure to do so will result in dismissal from program without refund. The Enrichment Reading staff will do its best
to ensure a safe experience, however I understand that accidents do occur. I hereby release The Enrichment
Reading Staff from any and all responsibility and liability of any nature resulting in my child’s participation in any
program accident including claims for any injury, illness, death, loss or damage. My signature gives permission to
use all photos and videos taken during programs for promotional purposes. To opt out of this, I will submit request
in writing. I have informed camp staff of my child’s medical conditions. All information given is accurate and true
to the best of my knowledge.

Parent/Guardian Signature: ________________________________ Date: __________

PAYMENT INFORMATION:

Method of Payment: MasterCard Visa Check (make payable to Enrichment Reading)

Total Amount Enclosed:______________________ Check#: _______________

CC# _______________________ Exp Date _________ Security Code _______

Name on Card: ____________________________________________________

Billing Address: ___________________________________________________

________________________________________________________________

Charge by phone: Call 678-522-8838

Mail Registration Form and Payment to:

Enrichment Reading
Attn: Bernae Okegbenro
Post Office Box 1364
Villa Rica, GA 30180

You will receive email or phone confirmation within one week of your registration.
If you are not notified within one week, please email or call Bernae Okegbenro at
Bernae@EnrichmentReading.com or 678-522-8838.