BGR Youth Enrollment Form! ๐ŸŒŸ

Hey there, future changemakers! ๐ŸŒˆ Ready to embark on an empowering journey with Brown Girl Rise? We're thrilled to have you!

๐Ÿš€ Why Join? By becoming a part of our programs, you're unlocking a world of opportunities to connect, learn, and grow. Get ready for exciting events, workshops, and a sisterhood that's all about joy, empowerment, and fierce love.

๐ŸŒ Stay in the Loop: Once you're in, you'll be in the know! Expect emails, notifications, and exclusive invites to upcoming BGR events, activities, and programs. Be the first to hear about the latest happenings and activities designed just for you.

๐Ÿค Your Privacy Matters: Your info is safe with us! Your privacy is our priority, we promise your information is for the BGR team only.

๐Ÿ“ž Hear from Us: Parents and Caregivers, get ready for some friendly phone calls, emails, and texts from Brown Girl Rise staff. We're here to keep you in the loop and make sure everyone's on the same page.

๐ŸŒŸ Grant Reporting Magic: Guess what? Your journey with Brown Girl Rise might just become a part of something bigger! Demographic info collected could be shared in our grant reporting process. Don't worry, though โ€“ we're serious about anonymity.ย 

We're excited to co-create with you!

Brown Girl Rise Teamย ๐ŸŒบ

Sign in to Google to save your progress. Learn more
Participant (Full Name) *
Participant's preferred pronouns *
Phone Number of Participantย  *
Participant Email *
Demographic Information: Birthdate *
MM
/
DD
/
YYYY
Demographic Information: Ethnicity, Race, and Language Spoken at Home *
Demographic Information: Participant's gender identity (ie: girl, femme, trans, non-binary etc.) *
Demographic Information: Do you identify as having a disability? *
Demographic Information: Participant Age *
Demographic Information: School Attending *
Demographic Information: Grade Level *
Participant Allergies & Medical History (Anything we would need to know to keep you full, safe and healthy during Brown Girl Rise Sessions.) *
Is there anything you need that will support your participation in BGR? (Ex: transportation assistance, interpretation, particular learning style, etc) *
How did you hear about us? *
Do you feel a connection to the culture of your ancestors/heritage? *
Do you have a trusted adult, other than your parents/caretakers who you feel safe discussing your problems or being your authentic self? *
When it comes to BGR ย gear which would you prefer: vest, beret, t-shirt, or hoodie? *
Required
Do you feel a connection to the land, city, and community where you live? *
Do you have friends who understand what it's like for you to be a Black, Indigenous, and/or Person of Color? *
Would you be interested in volunteering? *
Is there anything else you would like us to know about you? (What you want to learn, any issues you're passionate about, any experience you want to share.) *
Parent | Caretaker Full Name *
Parent | Caretaker Phone Number *
Parent | Caretaker Email *
Mailing Address:ย  *
Emergency Contact Informationย  *
BGR Participant Safety Promise:ย 
At Brown Girl Rise, we are committed to creating a space where everyone feels respected, valued, and secure. To ensure a positive and safe experience for all, we ask that you join us in reviewing and acknowledging the following Safety Promise:

Respect for All: I promise to treat everyone with kindness, respect, and understanding, regardless of their background, identity, or beliefs.

Open Communication: I promise to communicate openly and honestly, sharing my thoughts and feelings with the understanding that this is a safe space.

Physical and Emotional Safety: I promise to prioritize my and others' physical and emotional safety, creating an environment where everyone feels secure.

Inclusivity: I promise to embrace and celebrate our differences, fostering an inclusive and welcoming community.

Consent and Boundaries: I promise to respect personal boundaries and obtain consent before engaging in physical contact or sharing personal information.

Conflict Resolution: I promise to engage in conflict resolution constructively, seeking solutions through open dialogue and understanding.

COVID-19 Precautions: I promise to follow any COVID-19 safety guidelines provided by Brown Girl Rise to protect the health and well-being of everyone in our community.

Responsibility: I promise to take responsibility for my actions, understanding that they impact the community's well-being.

Supportive Environment: I promise to contribute to a supportive and uplifting environment, offering encouragement and assistance to my fellow community members.

Commitment to Learning: I promise to approach every experience as an opportunity to learn, grow, and contribute positively to the Brown Girl Rise community.

By making this Safety Promise, we collectively contribute to creating a safe, inclusive, and empowering space for everyone.ย 
 *
Required
Virtual hugs for taking the time to fill out our BGR Youth Enrollment Form!

Your commitment to self-discovery, sisterhood, community, and justice is inspiring! We're excited to co-create with you.ย 

Feel free to reach out to browngirlrisepdx@gmail.com with any questions, thoughts, or words of encouragement - we're here for you! ๐Ÿ’Œ

๐ŸŒˆ Welcome to Brown Girl Rise ๐ŸŒˆ
 *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms