GROW Youth Workshop

GROW Participant's information

*All information on this form must be filled out to be considered*

Name of Participant(Required)

First Last

Preferred Name(Required)

First

How does your young person identify? (ex, female, male, non binary, etc)

Which pronouns does your child/youth prefer?

Date of Birth(Required)

Age(Required)

Home Address(Required)

School(Required)

Grade(Required)

Teacher(Required)

Parent/guardian information

Person completing this form

Name(Required)

First Last

Pronouns

Relationship to Child/Youth(Required)

Home Address

If different than the applicants

Phone Number(Required)

Email(Required)

Preferred Method of Contact(Required)

Phone Call

Text

Languages Spoken(Required)

Emergency contact

Name(Required)

First Last

Phone Number(Required)

Relationship to Applicant(Required)

Other Information

Is there any important information regarding your child’s family life such as family dynamics, custody arrangements, mental health diagnosis, medical conditions, allergies, etc. that you would like the BBBSPV staff and GROW Program facilitators to be aware of?(Required)

Yes

If yes, please include them here

confidentiality

Is there anything here that you do not want shared with a volunteer or facilitator?(Required)

Yes

If yes, please clearly state what you do not want shared.

additional forms

Once we have received your application, we will follow up closer to the workshop date with additional forms that will need to be completed. These include a confidentiality agreement for both the parent/guardian and the participant, an informed consent form for the parent/guardian, and a media consent form. Please note that a photographer will be present at the event to capture moments from the workshop.

Comments

This field is for validation purposes and should be left unchanged.