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.
Email address *
First Name *
Your answer
Last Name *
Your answer
Your Email Address: *
Your answer
Your Phone Number: *
Your answer
Your Instagram (if you have one):
Your answer
What is the best way to contact you? *
Parent or Legal Guardian Name: *
Your answer
Parent or Legal Guardian Phone Number: *
Your answer
Additional Emergency Contact (close relative or family friend) NAME and PHONE Number: *
Your answer
Do you have any known allergies (food, medical)? If yes, please describe *
Your answer
How did you hear about re:imagine/ATL?
What programs do you participate in? (check all that apply)
What school do you attend? *
Your answer
What grade are you currently in? *
What is your zip code (example 30316)? *
Your answer
Gender identity: *
Which of the following best represents your ethnicity? Choose all that apply.
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?
What special opportunities have you experienced through re:imagine/ATL? (choose all that apply) *
Required
What is the highest degree or level of school your parent(s) or guardian(s) have COMPLETED? *
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.)
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) *
Please let us know if you have questions or program/event ideas for the re:imagine/team:
Your answer
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