Cooking Matters for Teens – Lewiston June 18 – July 23 CM Teens Lewiston June 18 - July 23 Wednesdays, 3:45-5:45pm June 18 - July 23 Boys & Girls Clubs of the Lewis Clark Valley 1021 Burrell Avenue, Lewiston, ID 83501 First Name*Last Name*Address*City*StateZip*Phone Number*Type of Phone*Cell/MobileHomeWorkEmail AddressEnter EmailConfirm EmailWhich language do you prefer?*EnglishSpanishDo you have children ages 0-5?*YesNoDo you have children ages 6-17?*YesNoCheck this box if you want to receive shopping and cooking tips from Cooking Matters once in awhile.Yes, I would like to receive updates from Cooking MattersDemographic Information1. What is your sex?*MaleFemale2. Age Group18-2425-3435-4445-5455-6465 or AbovePrefer Not to Answer3. What is the highest level of education you have completed?Less than a high school degreeHigh school degree or GEDSome college, but have not graduatedTwo-year college degreeFour-year college degree4. What is your race? (You may mark more than one.)WhiteBlack or African AmericanAsianNative Hawaiian or Pacific IslanderAmerican Indian or Alaska NativeOther (please specify)If Other, please specify:5. Are you Hispanic or Latino?YesNo6. Are you pregnant?YesNo8. How many children ages 0-5 live in your household? (This may include non-relatives who live with you.)9. How many children ages 6-17 live in your household? (This may include non-relatives who live with you.)10. Do you or other members of your household currently participate in any of the following programs? (Mark all that apply)WICSNAPFree or reduced-price school breakfastFree or reduced-price school lunchFree or reduced-price school supperFree summer mealsHead StartDo not participate in any of these programsI understand that Cooking Matters is not a drop-in program. I understand that groceries will be provided for me at each class session, and if I do not come to class, the cost of these groceries will be lost. I understand that by enrolling in Cooking Matters, I am filling a spot in a limited-entry program, and I intend to participate in all 6 sessions.*Yes, I have read the agreement and I intend to participate in all 6 sessionsHow did you hear about Cooking Matters?EmailThis field is for validation purposes and should be left unchanged.