Interest Form for Netivot Shalom Teen Social Justice Program

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Please indicate your level of interest in building a social justice toolkit and putting it to use with other teens at Netivot Shalom this year. To RSVP for specific events, click here: https://tinyurl.com/n9pefbuv. Feel free to get in touch with Yael at yael@netivotshalom.org or @yael_cns on Instagram.

First Name

Last Name

Pronouns (e.g. they/them, she/her, he/him, e/em)

Preferred email address

Cell phone number or Instagram handle

Which is better to reach you: email, phone, or other?

Grade in Fall 2021

What school do you attend?

Please list any dietary needs you have (gluten free, no dairy, kashrut needs, nut allergies, etc)

I am interested in participating...

fully, in all sessions and workshops

in most sessions

in a few workshops or events here and there

not at all

wish I could but I'm too busy

maybe, but I want to wait and see

Other:

Clear selection

What, if anything, would make you more likely to come to a workshop/event?

What topics, injustices, or actions are you interested in learning about and/or participating in? Are there any specific skills you'd like to acquire?

Parent First Name

Parent Last Name

Parent's Email

Any other comments, questions, or things you'd like us to know

Submit

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