LGBTQIA Youth Group 2022
Thank you for your interest in BRiDGES LGBTQIA++ Youth Group! We are currently meeting virtually, over Zoom, from 7-8pm on Thursdays. This information is just for us (so we can make Youth Group work for you) and will not be shared with anyone else
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What is your legal name? (first and last, please) *
What name do you want us to use for you in group? *
What is your birthdate? *
MM
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DD
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YYYY
Do you think you might want to celebrate your birthday at youth group? *
What grade are you in? *
What school do you go to? *
What pronouns do you use? Pick any that apply (if you use other pronouns, please let us know what they are) *
Required
What is your preferred method of contact? *
Required
Please include your preferred contact information (phone number, email, text number etc) here so that we can send you the Zoom link before Youth Group meetings *
What is your racial identity or ethnicity?  (white, Black, Native American, biracial, Polish, Latinx, etc) *
How do you identify your gender? (if you pick other, please explain) *
Is that the same as the gender you were identified with at birth? (For example, if you were told you were a girl (or a boy) when you were born, does that still feel like who you are?) *
Who is your emergency contact? (please provide first and last name, relationship to you, and a phone number for your emergency contact- must be an adult, over the age of 18, preferably your parent or guardian) *
What name and pronouns would you like us to use for you if we speak to your emergency contact? (if you have changed your name and pronouns, but your emergency  doesn't call you by that name, please tell us what they call you, and what pronouns they use, so they will know who we are talking about) *
What is your  STREET ADDRESS?  (this is for the house where you get mail in case we want to mail stuff to you- if you use a PO Box for mail, please include that with your house address) *
What City/Town do you live in? *
Zip Code (if you don't know it, you can google it or ask an adult) *
Is there anything else that you want to share with us? (like your favorite color, or food, or pet, or book, or TV show, or movie) *
Your Parent/Guardian will have to fill out a permission form for a BRiDGES  Youth Program before you will be able to attend youth group. Please provide contact info for them: First and Last Name, Phone Number, Email, or Mailing Address. (this form is a generic youth program form, and will not identify the purpose of the group, so it will not out you if you are not out to your parents/guardians. It is up to you if you share that info with your parents/guardians) Here is the link to the form: See QR Code Below
QR Code for the consent form:
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