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Brown Girl Rise 2021 Enrollment Form
This sign up for is for all NEW and RETURNING Brown Girl Rise members. Please make sure to fill out a form for each individual who wishes to participate in our programming this year.
This information will be kept confidential and will not be shared with anyone outside of the Brown Girl Rise leadership collective.
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Youth Participant Name
Your answer
Youth Participant's Preferred Pronouns
Your answer
Youth Participants Race/Ethnicity (self-identified)
Your answer
Youth Participant Age and Grade
Your answer
Phone Number of Youth Participant or Parent/Guardian
Your answer
Youth Participant Email
Your answer
Parent/Guardian Email
Your answer
Address where you receive mail/packages (all participants will receive a WELCOME package from BGR after submitting this form)
Your answer
Participant Allergies & Medical History (Anything we would need to know to keep you full, safe and healthy during Brown Girl Rise Sessions.)
Your answer
Is there anything in particular that will support your participation in Brown Girl Rise? (This could be anything - transportation assistance, interpretation, particular learning style, etc)
Your answer
How did you hear about Brown Girl Rise?
Your answer
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