Participant Registration
Please fill out this form to participate in the 2012 Chinatown Beautification Day!
NOTE: Clean-up day teams will be determined by ON-SITE REGISTRATION.

Please bring a waiver (for under 18) with you on both days of the event.
The waiver can be downloaded here: https://docs.google.com/document/d/1jSmkbEnV1y_RQlzUvfFYh5l4BdHNnKR_uBQxWZekg4w/edit
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Gender *
Age *
I am from... *
Name of High School / College *
Are you / have you been a member of the Summer Leadership Institute (SLI)? *
If you answered "No" to the previous question, what is your affiliated organization/group?
For PAST SLI Participants: Would you be interested in leading / coordinating on Clean-up Day?
You will be contacted if you are interested in leading small groups.
Clear selection
Check all that you are signing up for. *
The Youth Conference registration is now CLOSED.
Required
E-mail *
Phone Number *
Emergency Contact's Name *
Emergency Contact's Phone Number *
Your Emergency Contact's Relationship to You *
T-Shirt Size *
Clean-up Day volunteers will receive a free T-Shirt. Sizes other than the four listed may not be available.
Please note any dietary restrictions.
Do you need a community service letter? *
You may receive service hours for partaking in Clean-up Day.
How did you hear about CBD? *
What is your favorite Pokemon?
Clear selection
What is your favorite Hogwarts house?
Choose wisely. Or rather, it has already been chosen.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This form was created inside of Chinatown Youth Initiatives.