Personal Name *

First Name

Last Name

Emergency Contact *

Please add an emergency contact. We will only reach out to them if there is an emergency.

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Guardian Name- For youth under 18 yrs

Guardian Name who is giving consent

First Name

Last Name

Guardian Consent

I agree

I do not agree

Guardian Phone

For youth under the age of 18 yrs. For emergency purposes.

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Are you available to volunteer in the pre-planning phase?

Yes

No