The Cypha Open Mic Registration

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Thank you for your interest in The Cypha Open Mic. By completing this form you are requesting for us to contact you to discuss youth opportunities at South Side Help Center.

What Activity would you like to register for?

The Cypha Open Mic Teen Series (13-21 yr olds)

The Cypha Jr Open Mic Series (9-13 yr olds)

CREATE WORDS Writing Workshop (9-15 yr olds)

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Would you like to be a feature poet?

Feature poets are allowed up to 20 minutes to perform a selection of their work. In order to be considered you would need to submit a sample of your work.

Yes

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Youth First Name *

Youth Last Name *

Student Age

What grade are you in? *

What is you preferred method of contact? *

Text

Other:

Please submit your contact information for the above

Ex: If your preferred method is Text, input your text number. If it is WhatsApp, input your WhatsApp contact information.

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Phone Number *

Parent/Guardian Email

Mailing Address *

Submit

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This form was created inside of South Side Help Center.