Social Justice Youth Council [Ages 14-18] 2021-2022 Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Teaching Artist: Arianna Hurtado

Dates: Every other Monday starting April 4th (This club is preliminary - we plan to start again in the fall on a weekly basis) **If you're interested in joining but these dates don't work for you, let me know so I can take this into consideration when planning for the fall (NEW DATES)

Time: 7:00-8:30pm (NEW TIME)

Program Length: 10 weeks

Location: In person- NECS Office

Description: This NEW program is a youth-led leadership program that promotes civic engagement among youth of all backgrounds. It has been designed to equip teens with the critical thinking and leadership skills necessary to become engaged citizens who create positive change in their communities. Students will also gain community service hours for meetings and events.

Fee: FREE!

Registrant's First Name *

Registrant's Last Name *

Date of Birth *

YYYY

Grade *

Registrant's Email *

Registrant's Phone Number *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Phone Number *

Emergency Contact Phone Number *

Parent/Guardian Email Address *

Street Address *

City *

State *

Zip Code *

Clear form

Never submit passwords through Google Forms.

This form was created inside of New Era Creative Space Inc. Report Abuse

Forms