El Placazo Teen Participant Form
San Anto Cultural Arts' Community Newspaper, Podcast and Comic Book Program
Sign in to Google to save your progress. Learn more
Areas of interest (check all that apply) *
Required
Participant's Full Name *
Gender Identity (pronouns) *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Ethnic Identity *
Street Address, City, State, Zip *
Phone *
Email *
School Attending *
School ID or Lunch Number *
Current Grade Level *
Parent / Guardian 1's Name *
Parent / Guardian 1's Phone *
Parent / Guardian 2's Name
Parent / Guardian 2's Phone
Number of Siblings *
Number of people under 18 living in home *
Check any that apply to you
Does anyone in your immediate family receive any of the following government assistance benefits?
SNAP
Medicaid
TNAF
CHIP
(check all that apply)
How did you hear about our program? *
Required
Photo Consent (REQUIRED TO SUBMIT FORM) *
I herby consent to the use by San Anto Cultural Arts, or anyone acting under its authority, including photographs, sketches, mural paintings, video, voice recordings, or other images to which this consent applies are the property of San Anto Cultural Arts and San Anto Cultural Arts shall have the right to duplicate, display, and make other uses of such images, free and clear of any claim whatsoever on my part. I further certify that I am a custodial parent, legal guardian or am the registered participant of legal age and have the aforementioned rights to assign.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of San Anto Cultural Arts. Report Abuse
Google Forms