BAGLY Youth Registration
Hello and thank you for your interest in BAGLY's virtual programs! Fill out this form, and a staff member will be in touch with you soon. Please note that this is a one-time form. BAGLY programs are drop-in so once you receive information on our Zoom meeting links and passwords, you can simply drop-in to our weekly programming without pre-registration.

Please note: if you use a school-based email account, our emails to you might be blocked by your system administrator. Please use a personal email (if available) and make sure the spelling of your email is correct. Lastly, please check your spam or junk folder when looking for a response. Our emails are occasionally filtered into spam folders.

For more information on BAGLY's online programs, check out: https://www.bagly.org/programs

BAGLY is free of sex, drugs, alcohol, violence, weapons, peer pressure, and harassment. You can read more about our guidelines here: https://bit.ly/2EPGQLA

Feel free reach out to us at bclarke@bagly.org if you have any questions.
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Email *
First Name *
What should we call you? Note: this does not have to be your legal name.
Middle Name
Last Name *
Birthdate *
MM
/
DD
/
YYYY
Pronouns *
Select all that apply.
Required
How would you like to be reached *
Phone Number: *
Address:
State: *
Zip Code *
Please write in the Zip Code of the area in which you currently reside.
Emergency Contact Name and Relationship *
Name And Pronouns Your Emergency Contact Recognizes You By
 *
Emergency Contact Phone Number *
Are you Vaccinated for COVID? *
Gender Identity *
Select all that apply.
Required
*If Two-Spirit was selected, what is your tribal affiliation:
Sexual Orientation: *
Select all that apply.
Required
Languages Spoken *
Select all that apply.
Required
Race: *
We acknowledge that these categories may not capture all identities and experiences. Please let us know if you have feedback on how to better this form.
Required
*If American Indian/Alaskan Native was selected, what is your tribal affiliation:
*If Multiracial was selected, what are your racial identities?
Are you Currently - *
Required
Are you experiencing unstable housing or homeless? *
How did you hear about us? *
Would You Like To Receive Updates From BAGLY? Updates Regarding Programming, Job/Internship Opportunities, And Community Resources?
 *
Do you agree to uphold the BAGLY frees and community guidelines? *
BAGLY is free of sex, drugs, alcohol, violence, weapons, peer pressure, and harassment. Please read more about our guidelines here: https://bit.ly/2EPGQLA
A copy of your responses will be emailed to the address you provided.
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