Black Family Cook - Registration & Survey

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Healing Justice Santa Barbara (HJSB) is proud to collaborate with Santa Barbara Unified School District (SBUSD), for the first annual Back to School: Black Family Cookout. This partnership is a part of a series of Black-centered events and programming intended to uplift and affirm the experiences of Black students throughout the district.

The Back 2 School: Black Family Cookout is on Sunday, August 27th, from 12 PM to 4 PM at Franklin Elementary School (campus field).

Email *

Name: *

Email: *

Affiliation to Santa Barbara Unified School District (i.e., school child[ren] attends, staff, current or prospective SBUSD parent, or community member):
*

Please list the number of adults and/or children you plan on rsvp’ing for (i.e., 2 adults, 2 children). *

Please list any dietary restrictions below (i.e., vegan, gluten free, non-diary, child has gluten allergy, etc.):

If you are a parent or caregiver, what grade is your child(ren) in? Check all that apply:

0-3 years old

Preschool

Transitional Kindergarten - Kindergarten

Elementary School (Kindgarten - 6th Grade)

Junior High School (7th - 8th Grade)

High School (9th - 12th Grade)

Other:

If your child(ren) attends or will attend a SBUSD high school, what high school do they currently attend, or will they attend?

Dos Pueblos High School

San Marcos High School

Santa Barbara High School

La Cuesta Continuation High School

Clear selection

If your child(ren) attends one of the four high schools within SBUSD, are they interested in participating in Black Student Union? SBUSD has contracted with HJSB to provide organizational support to the Black Student Unions on all four high school campuses listed above.

Yes

Maybe

Clear selection

If so, please provide their contact information below (i.e., phone number or email). By providing your child(ren)'s contact information you are giving consent for them to be contacted by a HJSB representative.

What additional Black-centered support do you feel your child(ren) need in order to feel safe and empowered at school?

What additional Black-centered support do you feel your child(ren) need in order to feel safe and empowered in the community?

Would you be interested in joining a formal SBUSD Black/African American parent committee?
*

Yes

Maybe

Does not apply to me

Are you interested in receiving more information about future events and resources from Healing Justice Santa Barbara?
*

Yes

In order to promote the mission and programming of Healing Justice Santa Barbara (HJSB) and share your experience and knowledge with the community, we are requesting your written permission to use your name, presence, voice and photographs of you in our publicity and publications via our website, brochures, promotional materials (digital and printed), youtube, or any other media publications or deems fit.
*

I authorize HJSB to use my name, presence, voice, photographs, live-streaming and/or recordings that include me in HJSB publicity and media.

I do not authorize HJSB to use my name, presence, voice, photographs, live-streaming and/or recordings that include me in HJSB publicity and media.

For parents and caregivers of minor children:

I am the parent or caregiver of the minor(s) and have read the Publicity Agreement and Release and understand their contents. I consent to signature of this Publicity Agreement and Release by the minor(s) I am a parent or caregiver of.

Yes

This does not apply to me.

A copy of your responses will be emailed to the address you provided.

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