Rainbow Resilience Conference - Individual Registration 
This is the INDIVIDUAL registration for the Rainbow Resilience Youth Conference being held at Genesee Community College on April 19 from 9:30 am to 4:30 pm. Unfortunately, lunch orders have already been placed. If there are any extras, we will happily share one with you; however, you may want to bring a lunch or be prepared to buy one. 
Sign in to Google to save your progress. Learn more
Participant's name (affirmed/preferred)
Participant's email address or best email to send info to 
Participant's phone number
Pronouns (select all that apply)
Emergency contact's name and phone number 
Everyone will attend a workshop on preventing suicide and overcoming mental health stigmas. In addition, select your top TWO choices for the third workshop of the day.
Dealing with Difficult Family Members
Knowing Your Rights & Making Change
Embracing Authenticity: Faith, Love, and LGBTQ+ Identity
Life Onstage with Roger Rosen (he/him)
Top Choice for Workshop
Second Choice for Workshop
Clear selection
To keep everyone's energy and mood up, we will be having many shorter sessions focused on self-care. Please select your top THREE choices for this part of the day. 
Yoga (you'll need to remove your shoes)
Meditation self-care
Health snacking
Art for self-care
Journaling for self-care
Top Choice
Second Choice
Third Choice
Clear selection
Are you allergic to anything in the environment or food we should be aware of? Please explain. 
Are there any accommodations we can provide to make your experience as enjoyable and meaningful as possible? 
Is there anything else you'd like to share?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of glowout.org. Report Abuse
Google Forms