re:imagine/ATL Youth Registration
We are so glad you're part of the re:imagine/FAMILY and involved in our programs! We just need some information to help stay in-touch and to help keep you safe. We will keep your information confidential. Please answer these questions honestly and to the best of your abilities.
Your Email Address:
Your Phone Number:
Your Instagram (if you have one):
What is the best way to contact you?
GroupMe or messenger App
Through my parent/guardian
Parent or Legal Guardian Name:
Parent or Legal Guardian Phone Number:
Additional Emergency Contact (close relative or family friend) NAME and PHONE Number:
Do you have any known allergies (food, medical)? If yes, please describe
How did you hear about re:imagine/ATL?
What programs do you participate in? (check all that apply)
The Green Room summer camp
re:imagine/COMMUNITY (formerly Youth Unifying Youth)
What school do you attend?
What grade are you currently in?
High school graduate
What is your zip code (example 30316)?
Prefer not to say
Which of the following best represents your ethnicity? Choose all that apply.
Black or African American
Latino or Hispanic
East Asian or Asian American
South Asian or Indian American
Native American or Alaskan Native
White or Caucasian
Do you currently have a mentor through the re:imagine/ATL program?
Would you like a mentor through re:imagine/ATL?
What area of production would you like mentorship?
Videography (camera operation, cinematography)
Animation and visual effects
Art Department (set design, costumes, props)
Marketing and social media
Lighting, Electric, Grip
What special opportunities have you experienced through re:imagine/ATL? (choose all that apply)
Trip (cruise, travel)
What is the highest degree or level of school your parent(s) or guardian(s) have COMPLETED?
12th grade - no diploma
High School diploma
Some college credit, no degree
Bachelor's or Associate's degree
Master's degree, professional or doctorate degree
What are your plans after completing high school? (It's okay if you're not sure yet. Select what you think you're interested in.)
Attend a 4-year college
Attend a technical school
Get a paid internship
Stay in Atlanta and pursue a job in the film or music industry
Pursue a career in film or music outside of Georgia
Film certification program with GA Film Academy
Do you plan on pursuing a career in film or music production?
Did you and your parent/guardian sign the re:imagine/ATL WAIVER for photo/content release to participate in re:imagine's programs? (1-page document back and front with space for student and parent/guardian signature on back)
I don't know
Please let us know if you have questions or program/event ideas for the re:imagine/team:
Send me a copy of my responses.
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