JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Communities Talk Registration
Please complete the following form to register for CACY's Communities Talk Town Hall Event on April 28th from 5-6pm via Zoom.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Number of people attending
*
Your answer
Email Address
*
Your answer
Age group of participant(s)
*
12-14
15-17
18-20
21-24
25-44
45-64
65+
Required
Zip Code
*
Your answer
What percentage of youth ages 12 to 18 in Richland County, do you think have had at least one drink in the past 30 days?
*
10-20%
21-30%
31-40%
Over 40%
Do you feel prepared to explain to teens why it is important to not drink underage?
*
Yes
No
Somewhat
Not much
What might prevent you (the adult) from talking to a teen about the dangers of underage drinking?
*
I don't know how to start the conversation
I'm not sure how to explain the consequences of underage drinking
I drank as a teen, so I don't see it as a problem
I feel underage drinking is a part of growing up
I'm unsure of the dangers of underage drinking
Other:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Community Action for Capable Youth.
Report Abuse
Forms
