The Lighthouse at Christ Episcopal Church - Participant Information
This information will used for communication and safety purposes only.
Sign in to Google to save your progress. Learn more
Participant's Name (as they would like to be called) *
Participant's Last Name *
Participant's Pronoun(s) (optional)
Participant's Date of Birth *
DD
/
MM
/
YYYY
Participant's Cell Phone Number (optional)
Emergency Contact Name *
Emergency Contact's Cell Phone # *
Would you (the parent/guardian) like to be added to our GroupMe group? (Text service for updates about Lighthouse programs, your cell number remains hidden.) *
Does the participant have any allergies, medical conditions, or concerns we should be aware of to keep them safe during Lighthouse programs? If so, please provide detail here. *
Additional Parent/Guardian name (optional)
Email address(es) for future communication
The Lighthouse at Christ Episcopal Church is an affirming space for LGBTQIA+ teens. Lighthouse participants have the opportunity to share experiences of identity and connect with others in friendship. Our gatherings are open to everyone in Jacksonville and the Beaches area. The Lighthouse does not provide therapy or counseling, but we are able to recommend resources for those who may need additional care. All participation in the Lighthouse is voluntary, and is not a statement of a person’s sexual orientation or gender identity. The Lighthouse seeks to provide love and acceptance for all people in their wholeness, as defined by them, without any outside judgment or pressure of any kind. Information that is shared in youth and parent gatherings is not shared by leaders between the two groups or with others, except in cases when a participant may be in an abusive situation or may be a danger to themselves or to others. In such an instance, we may be required to make a report or to contact a participant's parent/guardian. *
The Lighthouse is rooted in our desire, as Episcopalians, to respect the dignity of every human being, but The Lighthouse Youth and Parent Communities are non-religious in nature. People of all faiths and no faith are welcome, and leaders do not proselytize. Outside of The Lighthouse, the church hosts Youth Ministry events which are religious and are affirming of LGBTQ people. Would you like more information about these events? *
How did you hear about us?
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