Youth Healthy Relationships™ Participant Sign-Up Form
I'm so glad to see you here. I love it when there are ways to STOP pain BEFORE it hits our community - the Black community! This is what this is - an opportunity for you to find out what healthy relationships look like. 

Now don't think this is the boring way to do this because it's not. You get to examine your favorite TV shows, music, and movies applying what you'll learn to determine whether this is a relationship that models healthy or UNhealthy behavior. 

You get eat some of your favorite foods while you do this. 

You get to provide information to the caring adults in your life - so they can be modeling what you're learning, so your environment becomes a healthier, safer place for you to practice healthy relationship habits. 

You are eligible if you are a middle school or high school youth. That's IT. That's all. You won't need any money, just time and willingness to participate. 

If this sounds dope to you, GOOD; you need to sign up below! We are currently signing up for our waitlist for date later in this year! The class is full at 8 youth; if you are in that count, you will receive an email invitation for this class! 

This form will allow you to be placed on the list for our 8-week youth group. Due to the very intimate work you do in these sessions and the free-flowing nature of the conversation, and hey, the fact we gotta feed y'all - there are only 8 youth maximum in it at a time. At present, we have 1 youth facilitator; therefore, we will do this strictly on a first-come, first-serve basis.

**If you are outside of that number, don't worry! We'll place you on the waiting list and will match the next 8 based on your schedule availability to form the class. You will be emailed when a spot is available; please be watching for it. The session schedule will be based on participant/facilitator availability; please be accurate in sharing your availability on this form.**

IMPORTANT: We KNOW your privacy and safety are important. Please know we will NOT share any of this information with anyone who is NOT coordinating this program!

Please note: If you are unable to attend all 8 sessions, the learning will not be successful. Due to this fact, please understand that I will have to unenroll you if you start but are unable to finish all 8. If that happens, I will reach out to you, let you know. If you a cohort and do not finish, I will have to have you pay $11.24, which is the cost of the materials. This work is grant funded or self-funded by myself as the leadership of this organization. In order to continue this programming, we need to recoup any costs that do not go to help youth get this life-changing information. Thank you in advance for your cooperation with these guidelines.

We can't wait to provide this access for you!

Blessings,
Courageous Fire, Executive Director
Courageous Access
Sign in to Google to save your progress. Learn more
Email *
Please provide your first and last name *
Please provide your youth's first and last name *
Parent/Guardian Email *
Youth Email *
Please provide your best contact phone number *
Please check all that apply: *
Required
Please check the one that best applies to you: *
Are you in middle school or high school? (Select only one option, pls) *
Will you need transportation? *
If you answered "yes" to the previous question, please list your address below *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy