Your Information (whoever is filling out the form)
Enter your name below. If you are registering on behalf of group, please write your name below then indicate the number of youth and staff that will be in attendance under group registration.
First Name *
Your answer
Last Name *
Your answer
Group Registration (Families/Group Homes/Shelters etc.) Please indicate the number of youth and Staff that you are bring below. (Example: 8 youth/3 staff)
Your answer
How do you identify? *
Agency Affiliation *
Phone Number *
Your answer
If you have a birthday in November, please provide your date of birth below, Change 1 wants to celebrate with you!
Your answer
Do you need transportation? *
Pick up Address
Your answer
If the address you listed above is not the address you will be at on the day of the event, please provide a location so we can coordinate transportation. i.e. address and if its located North, South, East or West.
Your answer
Have you participated in a previous Thanksgiving Celebration? *