Columbia County Kick-Off Event Registration

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Youth Era is expanding to provide peer support in Columbia County. If you are a youth/young adult or parent interested in joining us for a virtual kick-off event on Zoom to learn more about what peer support is or sign up for services, please fill out this registration form. Thank you for your support!

Name *

Email *

Phone Number *

Which of the following best describes you? *

Youth or young adult interested in receiving peer support or learning more

Community member who is interested in learning more

Parent of a youth or young adult who is interested in learning more and signing up youth for services

Other:

If you are a youth/young adult interested in signing up for peer support, how old are you?

What City in Columbia County do you live in? (This helps us know where our staff will be providing peer support.) (Optional)

What questions do you have about Youth Era's virtual peer support services? (Optional)

Is there anything else you would like to add? (Optional)

Submit

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