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Youth Campus Registration Information
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* Indicates required question
What is the youth's name (Preferred First and Last)?
*
Your answer
Youth's Pronouns
*
Your answer
What is the age of the youth?
Choose
11
12
13
14
15
16
17
18
19
20
21
What kind of educational system is the youth registered in?
*
Registered in a School Division
Registered in online/distance learning
Registered in any form of post-secondary education
Registered in an education program, but not able to attend
Not currently registered in any education programs
Other:
Any health (physical or mental) concerns or diagnoses we should be aware of?
Your answer
What is the youth's current living situation?
Your answer
Youth Contact Number
*
Your answer
Can we text the above number?
*
Yes
No
Other contact number (guardian, support worker, community agency representative, etc.) if applicable?
Your answer
Can we text the above number?
Yes
No
Clear selection
Any additional information you'd like us to know?
Your answer
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