Bellevue Breakfast Rotary Club                                                                              Region 2 CA


5th Annual

Rotary Family Fest


Family Registration Form


·      Saturday October 20, 2012      11:00 am – 1:00 pm

·      Woodridge Elementary School

12619 SE 20th Pl Bellevue, WA 98005


The following family would like to attend the Region 2 Rotary Family Fest Event:

Name (s)      

Address        City        Zip      

Phone         Email      

Family Worker Information:   Family Worker’s Name      

Phone       Email      


Address       City         Zip      

Homestudy Approval Date        Is the Family Licensed?       

Does this family consent to be photographed/videotaped         YES           NO


Families must be registered by their agency worker and a confirmation will be sent to the family and the agency worker.  Space will be limited to the first 30 families. 


Signature                                                                 Date                                                                                                             

                      *signature not required for emailed registration


Please send Family Registration forms via email to:


Laurie Mayer, MSW

Region 2 Office of Adoptions & Permanency Planning

ph. 425.590.3081