Chuck Yo Weed Application! Presented by Save Foundation x Impact Sac!
Teen Leads will work together to increase awareness about the risks of underage marijuana use & improve outcomes for themselves, their peers, and the community.  As a teen lead, you will receive paid training, and learn creative marketing skills to create a youth-friendly campaign! 

Let's get started by answering some questions to help us get to know you better.
 
Sign in to Google to save your progress. Learn more
First & Last Name *
Address *
Street Address, City, State, Zip Code
What school are you attending? *
Type N/A if non-applicable 
Birthdate *
MM
/
DD
/
YYYY
Age *
Gender *
Ethnicity/Race *
Phone number *
###-###-####
Instagram @ *
Type N/A if non-applicable 
Email *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Liberty Towers Church.

Does this form look suspicious? Report