Step 1: Registration for 4-Hour Drug Class at AFY
**YOU MUST HAVE A VALID EMAIL ADDRESS TO COMPLETE REGISTRATION.

If you do not have an email address, you may visit www.google.com/gmail to create one.

You can only complete this process once. Please carefully review your answers before submitting.

*Note: Registration is not complete until you have paid for and obtained a ticket to attend class. Please read the confirmation message upon submission carefully for instruction on how to complete the registration process and secure your seat in a class.

E-mail address *
Your answer
First Name (Teen) *
Your answer
Middle initial (if no middle initial, please enter n/a) *
Your answer
Last name *
Your answer
Parent/Guardian participation in this class is required. Please check the box below indicating that you understand you must bring a parent/guardian to class with you. *
Required
#1 Parent's/Guardian's First name *
Your answer
#1 Parent's/Guardian's Last Name *
Your answer
#1 Parent/Guardian Attending Class? *
Required
#2 Parent's/Guardian's First Name
Your answer
#2 Parent's/Guardian's Last Name
Your answer
#2 Parent/Guardian Attending Class? (select "No" if you have not entered Parent #2 Name) *
Required
Phone number *
Your answer
May we leave a voice message at this number? *
May we send text messages to this phone? *
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip code *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Gender *
Which school district do you live in? *
What school do you attend? *
Please do not use abbreviations, but spell out the name fully. If you are not currently a student, enter "None".
Your answer
Do you (or your parent/guardian) need an interpreter in class? *
If you don't speak English, you need an interpreter.
If you need an interpreter, what language do you speak?
Ethnicity
Did you receive a ticket, citation, or summons from a police officer (including your school's SRO police officer)? *
Who is requiring you to attend this class? *
Notice to Disclose
If you are registering because you are being required to attend this class due to a ticket, citation or summons and/or a direct referral from a participating school district, you are granting Alternatives for Youth/iTHRIVE permission to disclose registration information (completed/incomplete), anticipated dates of attendance, attendance records, and record of completion to the referring body upon request. While we will provide informal record of completion, it is not the responsibility of this organization to provide proof of completion directly to the referent. Please be sure to update your referent and keep your completion certificate to prove your completion. We also reserve the right to report to the referring body in such cases as registrants be deemed unsuitable or ineligible for the program.
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service