Welcome to Seacoast Outright's Virtual Youth Group: Every Friday Night at 7:00pm
Seacoast Outright wants to ensure that LGBTQ youth feel supported, safe, and make connections with other youth in our community. In order to do this, we need a bit of information about new users like you - just fill out the short form below. A facilitator will review, then send you the Zoom invitation VIA YOUR EMAIL ADDRESS, for you to join us.

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QUEER MEERKATS UNITE!
Zoom User Name *
Name *
Age *
Birthday *
年
/
月
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日
City, State *
Email address: we will use this to invite you to meetings. (If you are in middle school, do NOT use your school email address - it will bounce back!) *
Please provide your phone number in case we need to verify this is you or there is an issue with your email!
Pronouns
Gender Identity
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Sexual Orientation
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Are there other resources or support that you need (food? housing? mental health counseling?). May we contact you via email (or please provide phone number)?
Please add an emergency contact such as phone number or email (example: Mom Linda 603-000-000) *
提交
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