BYE Bystander Intervention Workshop Registration Form
If you identify as a Black youth (Black-African ancestry/heritage) and attend high school in British Columbia, Canada, complete this registration form and we will contact you when the date and time are announced. For this workshop, the maximum number of participants is 15. The workshop will take place on June 30th, 2021 from 5:00 - 7:00 pm (via Zoom).

We are asking these questions to ensure a diverse group of participants. We’ll keep all your information confidential.

Please fill out this form by June 17th if you would like to attend this workshop.

Sign in to Google to save your progress. Learn more
Personal information
We want to know a bit more about you, and we ask these questions to ensure that we have a diverse group of participants in our workshop.
Name *
Grade *
What school do you go to? *
How old are you? *
What is your nationality? (ex: Canadian) *
What country were you born in? *
What is your ethnic heritage? (ex: being African-Canadian, Jamaican-Canadian, etc.) *
What is your gender identity? (ex: girl, Two-Spirit, non-binary, queer, boy, trans, genderfluid, agender, etc.) *
What is your sexuality? (ex: bisexual, gay, lesbian, straight, questioning, asexual, etc.)
This question is optional
Contact information
You can also use your caregiver's information if you feel more comfortable with that
What is your (or your caregiver's) phone number?
What is your (or your caregiver's) email address?
Would you like to receive emails about our programs in the future?
Clear selection
Questions about your past experiences
We want to know what brings you to this workshop, and what past experiences you have had with racism and bystander intervention at your school.
Have you been to a Project Respect workshop before?
Clear selection
If yes, which ones? (check all that apply)
Have you experienced racism at your school?
Clear selection
Have you been asked for the "n-pass"/ been asked for permission to say the "n-word"?
Clear selection
Have you ever intervened in a race-based incident?
Clear selection
If yes, please describe the incident below:
Thank you for completing this registration form!
Filling in the form does not guarantee a spot in the workshop, as space is limited. We will contact you as soon as possible at the email address that you have provided if we have a spot for you! We hope we will be able to offer more workshops like this in the future - please follow us on Instagram at @b.y.e.victoria for updates.
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