Participation Questionnaire for Youth of COVID-19

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Youth of COVID-19 is an exhibition project run by the Youth Council at THEMUSEUM in Downtown Kitchener. This project aims to document and contrast the experiences of Canadian youth who have been directly and indirectly affected by the COVID-19 pandemic. Participation in this project will entail two interviews that will be placed six months apart. If you choose to participate in this project you can change your mind and back out at any time. This form is intended to gather baseline information to ensure that there is a balanced group of participants. All information entered here is completely confidential. Please feel free to contact Youth Council regarding any questions about this form or the larger project, we look forward to working with you.

E-mailadres *

Please Enter Your Full Name *

Please Enter Your Current Age *

Please Enter Your Age in Six Months *

Have you been DIRECTLY (had COVID-19, had a close family member or friend get sick) or INDIRECTLY affected by COVID-19? *

Directly

Indirectly

Please give a short statement on how COVID-19 has affected you. (Max 200 words) *

Are you comfortable with having your name released as part of this exhibition? *

Yes-I am comfortable with having my real name used

No-I would prefer to remain anonymous

Undecided

Anders:

Are you comfortable with your face being shared as part of this exhibition? *

Yes- I am comfortable with video formats

No- I would prefer to use an audio only format

Undecided

Anders:

Please provide an email address that is best to reach you at. *

If you are under the age of 18 please provide the name and email address of your parent/guardian.

If you have any questions/comments please feel free to enter them here or reach out to us at themuseumyouthcouncil@gmail.com

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