Photovoice Youth Art Workshops Registration
Photovoice Art Workshops for youth ages 13-18 is an opportunity to create photos and raise awareness about the negative effects of secondhand smoke from tobacco, vaping, and cannabis in living environments. Presented by staff of the Tobacco-Free Partnership Covina/West Covina a Program of Social Model Recovery Systems.
Contact for information: Elsa Greno, (626) 608-8314 egreno@socialmodel.com. After we receive your application
you will receive a follow-up e-mail or mailed letter with the consent forms.
Return address is:
Tobacco-Free Partnership
223 E. Rowland St.
Covina, CA 91723
Email address *
What is your City of Covina zip code?
What is your City of West Covina zip code?
Name of school you attend in Covina or West Covina?
First and Last Name *
Street Address, City, Zip Code *
Date of Birth *
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DD
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Phone number *
Emergency Contact Person: *
Emergency Contact Phone: *
I will sign and obtain parents/guardian signature on the following forms after I receive them by e-mail or USPS mail: (1) Participant Consent Form, (2) Image Consent and Release Form. If I don't return the forms by email or USPS mail I will not be allowed to join the first session. *
Required
Do you agree to participate in 6 weekly online sessions for 75 minutes each? *
Required
If you answered maybe or unsure what type of support would help you participate in this workshop?
All participants who complete at least four (4) online sessions will earn $30.00 e-gift card. Can you join at least 4 out of 6 online sessions? *
What days or times are you free to participate? (Select up to 3)
2PM - 3:15 PM
4PM - 5:15 PM
5PM - 6:15PM
6PM - 7:15PM
Tuesday
Thursday
A copy of your responses will be emailed to the address you provided.
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