SWAG House Registration
The following questions are to be answered by the teen participant.
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Legal Name *
Preferred Name
Preferred Pronouns *
Phone Number *
Is texting okay? *
Date of Birth *
Home Address (including city) *
Allergies *
Dietary Restriction(s) *
Special Interests/Skills *
What school do you go to? *
What grade are you in? *
How do you plan to get to SWAG House? *
Anything else you want us to know?
Did you read and understand all of the SWAG House rules? (Available on the website) *
The following questions are about the Parent(s)/Guardian(s)
Parent/Guardian Name(s) *
Parent/Guardian Phone number(s) *
Is texting okay? *
Emergency Contact (Besides Parent or Guardian already listed) *
Emergency Contact Phone Number *
The following people may NOT pick up my teen *
Parent/Guardians, can your teen drive themselves home? *
Parent/Guardian, what should we know about your teen?
Parent/Guardian, Please consent to the following *
If there is a choice, which medical center would you like to have your teen transported to? *
The following questions are for funding purposes only. Please answer any that you are comfortable answering. All answers will be kept confidential.
How many people aged birth-18 live in your home?
How many people over 18 live in your home?
Do you rent or own your home?
Clear selection
What is your teen's GPA?
What is your race
Clear selection
Do you qualify for government assistance?
Clear selection
Thank you for registering for SWAG House!
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