ORY Youth Intake Form
Hi there! We are so excited to have you join OUTright Youth! Please fill out the form below to help us learn a little more about you! We cannot wait to get to know you better and support you along your journey.

Filling out this welcome form says that you have read and agree to adhere to the following rules at the OUTright Youth Center:

OUTright Youth Rules/Norms


  1. Respect the space and each other

    1. No throwing things at each other

    2. No running/horseplay

    3. No defacing property (artwork, stickers, paint, etc.)

    4. Be courteous and attentive with our guests. They are professionals who volunteer their time and talents to come share with us.

    5. Remain in our center during group and exit only through front doors (do not access back doors or alarm will go off)

  2. Keep discussions PG rated

  3. No outing, ever. What happens at ORY stays at ORY and is private

  4. Call and Response: There will be a call and response each week with the activity leader(s). If you hear the call, respond immediately by paying attention and responding with the dedicated response, then remaining quiet and attentive. (Example: call - “Who lives in a pineapple under the sea?” response - “SPONGEBOB SQUAREPANTS”)

  5. Speak for yourself - use “I” statements whenever possible in discussions. Everyone is different and deserves to have their opinion and experiences heard and understood.

  6. No social media connections between staff/volunteers and youth, except for our private Discord server. See Rachael to join our Discord server, with parents’ permission.

  7. Adult supervision is required at all times except for using the restroom, and ONLY ONE PERSON IN THE RESTROOM AT A TIME. No exceptions. 

    1. During a private discussion with an adult, another adult should be present as a witness.

    2. During group, youth must remain in line of sight to at least 1 adult at all times (except when using the restroom or in quiet room)

  8. Quiet Room: 1 person per quiet room, no exceptions. If an adult is needed in the quiet room, 2 adults must be present with the youth.

  9. No PDA. This is a youth center for fellowship, not a place for dating. Please respect each other and each person’s personal space.

  10. Cleanup: ALL staff, volunteers, and youth must participate in cleanup at the end of each group:

    1. Recyclable plastic, glass, and cans should all go in the sink to be rinsed and dried. If you are unsure what is recyclable, ask an adult. Cardboard and paper should go directly in the recycling bins.

    2. Trash Sweep: Everyone is responsible for the space. When cleanup time is announced, please do a sweep for trash/recyclables in your immediate area (within 10 foot radius). 

    3. Put away whatever you have gotten out. If you are using craft supplies for a group activity, help the staff/volunteers put away the supplies. 

    4. Cleaning surfaces: please wipe down tables and countertops that have been used during group with antibacterial wipes.

  11. Vacuuming: One adult should vacuum the floors after each group.

  12. If you need help with anything, including understanding these rules, ask an adult, particularly the Program Director or Executive Director.

  13. Failure to follow these rules will result in a call for parent/guardian to immediately pick you up and you will be restricted from attending the following week. Continued failures to follow the rules will result in being uninvited to the group for the foreseeable future.

HAVE FUN, BE YOURSELF, SPREAD JOY.  😊
Sign in to Google to save your progress. Learn more
Email *
What location will you attend mostly? You are welcome to attend any group, but we will let you know about specific things in your area.
Clear selection
Name *
Pronouns *
Full Legal Name (For emergencies only) *
Assigned Sex at Birth (for use in emergencies only) *
Sexual Orientation (For demographic purposes only) *
Gender Identity (For demographic purposes) *
Romantic Identity (For demographic purposes) *
Physical Address *
Email address *
Phone Number *
Do we have permission to contact you? *
What is the best way to contact you? *
Birth Date *
MM
/
DD
/
YYYY
Age *
Level in School (If any) *
Which school do you attend?  *
Member of LGBTQ+ Club through School? *
Allergies (Environmental, Medication, etc. - including intolerances!) *
Medical needs (if any) *
Emergency Contact: Name *
Emergency Contact: Relation to youth *
Emergency Contact: Phone Number *
Emergency Contact: What name and pronouns do they use for you? *
Legal Guardian(s) Name(s) *
Legal Guardian(s) Home Address (if same as above, please re-enter) *
Legal Guardian(s)' Email Address *
Legal Guardian(s)' Phone Number *
What name/pronouns do you go by to your parent(s)/legal guardian(s)? (In case of emergency) *
Are you out to your parents/guardians? *
How did you hear about OUTright Youth? *
ORY posts updates to our youth group events and programming on our private Discord. May we add you to the private Discord? *
If yes, add your Discord handle here!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of OUTright Youth of Catawba Valley.

Does this form look suspicious? Report

Google Forms