Youth Rites of Passage and Project Bloom Registration: July 24-31, 2022
Welcome and Blessings from the Earthlodge Center for Transformation. We are so happy you're here. This form is for both Youth Rites of Passage (Ages 12-16. Facilitated workshops for youth cultural, spiritual and emotional development) and Project Bloom (Ages 17-21. Peer-to-peer youth led discussion group and empowerment workshops).

Below, please specify which program you'd like to attend. You're welcome to attend one or both! If you have any questions please contact the program coordinator Iyatunde Folayan at iyatunde@earthlodgecenter.org.
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Email *
Which program(s) are you registering for? *
Required
Parent or Guardian Email *
Youth Email (not required)
Name of Youth *
Parent or Guardian Name *
Full address including zip code *
Phone number *
Emergency Contact: name and phone number *
The following questions are about the Youth joining us. We ask for internal use only at the Earthlodge so we can track the demographics of the group and adjust programming to best serve our participants.
Age *
Ethnicity *
Gender Identity *
What interests you about the program? (1-5 sentences) *
Will you be able to attend all of the program? Which days are you able to attend? Sessions are from 12pm to 3pm. *
Required
Do you or your Youth have any food allergies? Please specify. *
Do you or your Youth have any mobility issues or access needs? Or any medical or mental health issues which need support? Please specify. *
We will require covid Rapid Testing before our sessions. The tests will be self administered and provided at no cost to you. Do you consent to Rapid Testing before our sessions? *
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