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Outlet Initial Contact Form
Please do not fill out this form more than once. Outlet Staff will email you once your form is submitted. If you haven't gotten an email within 2 business days please check your spam folder for an email from the domain @
acs-teens.org
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* Indicates required question
Name You Go By (First and Last)
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Your answer
What youth group(s) would you like to join? ( Check all that apply)
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LGBTQIA+ Youth Group (Ages 10-18) Mondays 4:30-6:00pm
QTBIPOC Group (Ages 14-25) Tuesdays 6:00-7:30pm (English and Spanish Speaking)
Trans Group (Ages 14-25) Thursdays 6:00-7:30pm (On Zoom)
Required
Date of Birth
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MM
/
DD
/
YYYY
Cell Phone
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Your answer
Email Address
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Your answer
Language(s) Known
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Your answer
School ( if not applicable write N/A)
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Your answer
Street Address
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Your answer
City
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Your answer
Zipcode
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Your answer
Who should we say we are if we contact you?
*
Outlet or Pride Center
ACS
Use our first name
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