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Youth Member Registry
Grade 9 & Grade 11 Meetings: Tuesdays @ 7:30pm
Grade 10 & Grade 12 Meetings: Wednesdays @ 7:30pm
*$25.00 Membership Fee for Grades 9-12*
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Preferred Pronouns
*
Female (She/Her)
Male (Him/He)
They/Them
Prefer not to say
Other:
Required
Specific Program/Service
*
Grade 9 Group
Grade 10 Group
Grade 11 Group
Grade 12 Group
Embrace (LGBTQ+) Group
Grade 8
Required
Address (Street, City, Postal Code)
*
Your answer
Are you currently living at home?
*
Yes
No
Cell Phone Number
*
Your answer
Email Address
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Name of School
*
Your answer
Parent/Guardian (1) First/Last Name
*
Your answer
Phone Number
*
Your answer
Address
Your answer
Email Address
Your answer
Parent/Guardian (2) First/Last Name
Your answer
Phone Number
Your answer
Address
Your answer
Email Address
Your answer
Submit
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