We Are Family (WAF) KidSpace Interest Form
This form is for youth and their parents! If you are a parent/guardian, please support your youth in completing this form, but fill out spaces with your youth's information (i.e., For name, date of birth - put the youth's name and date of birth, not yours!)

This membership form is for youth entering our services. You can email chandlerm@waf.org with your questions and we will work to link you to supportive resources in our community. Note: We place people into programs based on the birth date/age submitted in this form. 

A staff member will contact you after you fill out our online youth membership form. Please do not use a phone number or email that is not safe for a staff member to contact you.

PLEASE READ CAREFULLY AND FILL OUT THIS FORM TO THE BEST OF YOUR ABILITIES
In Google anmelden, um den Fortschritt zu speichern. Weitere Informationen
How did you hear about WAF? *
What is your date of birth (include year)? *
Datum
What is your current age? *
What is your chosen first name (the name you would like to be called)? *
What is your chosen last name (the name you would like to be called)? *
Is your legal name the same as your chosen name? If not, please write your full legal name, which will be kept private.  
Pronouns are used as a way to identify or refer to someone. Common examples of pronouns are they/them/theirs, she/her, or he/him, but there are many more options. What are your pronouns? *
Pflichtfrage
What is a safe phone number to reach you at? Please give us a safe number we can reach you at as a staff member from We Are Family. *
What is your email address? This is the email your group invite and program information will be sent to, so make sure it is correct! *
Please provide if you have a social media account/screen name for us to reach you (include whether it is Facebook, Instagram, etc.):
Please list your address including city, state and ZIP. If you have no permanent address or are not comfortable sharing your address, provide the ZIP code of where you spend the majority of your time. *
What is your ethnicity or racial identity? *
Are you Hispanic or Latino/Latinx?
Auswahl löschen
Sexual orientation refers to who you are physically, emotionally, and/or romantically attracted to. When you think of your sexual, romantic, and/or emotional interests, do any of these terms describe you? *
Pflichtfrage
Do you identify with being Intersexed? Intersex is a general term used for a variety of situations in which a person is born with reproductive or sexual anatomy that doesn’t fit the boxes of “female” or “male.” From: https://www.plannedparenthood.org/learn/gender-identity/sex-gender-identity/whats-intersex
Auswahl löschen
Gender Identity refers to how you see yourself. It is an internal experience. When you think of your gender identity (or expression), do any of these terms describe you? You can select as many as you desire. *
Pflichtfrage
If you are in school, What school do you attend? (If you participate in home school, what program are you in?) If you are in school, What grade? *
Have you ever been in Foster Care? *
What is your current living/housing status? *
Do you qualify for free or reduced lunch? *
Do you have any medical conditions we need to know about? If you are a person with a disability or medical condition that requires a reasonable accommodation, please let us know what support services you need! *
Do you have reliable transportation to group meetings? *
What programs do you want to be involved with or learn more about? Check all that apply! *
Pflichtfrage
What are your interests? What type of activities do you enjoy? We want to make sure we create activities for everyone to enjoy. *
Emergency Contact Information
Please provide contact info of someone we can reach if a serious concern arises or if there is an emergency. Please try to include your legal guardian's or parent's information or a safe adult in your life.
1. Emergency Contact Name *
1.Emergency Contact Pronouns *
1. Emergency Contact Relationship *
1. Emergency Contact Phone Number *
1. Emergency Contact Email *
2. Emergency Contact Name
2. Emergency Contact Pronouns
2. Emergency Contact Relationship
2. Emergency Contact Phone Number
2. Emergency Contact Email
When contacting your emergency contact, what name should we use? *
When contacting your emergency contact, what pronouns should we use? *
If you are a parent helping a youth complete this form, do you want to be sent info on joining our support group for parents, ParentSpace? *
DUTY TO WARN/DUTY TO PROTECT: *
If any representative of We Are Family believes that I am in physical or emotional danger or I am a danger to another human being, I understand that the representative is required by law to contact medical or law enforcement personnel to prevent harm to me or another person, and may contact the person in danger.
CONFIDENTIALITY & MANDATED REPORTING: *
I understand that discussions between myself, We Are Family, and referred programs as well as any records are confidential with the exceptions noted below. No information will be released without my written consent unless mandated by law. Possible exceptions to confidentiality include but are not limited to the following: abuse of any other person, sexual exploitation, AIDS/HIV infection and possible transmission, criminal prosecutions, child custody cases, suits in which the mental health of a party is in issue, situations where the staff has a duty to disclose, or where, in the staff's judgment, it is necessary to warn or disclose. Some of We Are Family staffers are Mandated Reporters. Mandated Reporters must report suspected child abuse or neglect to the South Carolina Department of Social Services. Read more information here: https://dss.sc.gov/child-well-being/mandated-reporters/ 
Statement on COVID 19 and in person events and meetings *
It is very important that we do our part to restrict the spread of disease while sustaining programming for our community. Please understand that each person who attends in person events are doing so at their own risk. We Are Family is not responsible for a participant's possible exposure to COVID-19 while participating in our programs. All people who wish to attend in person events are encouraged to be vaccinated. We require participants to wear masks for indoor meetings at our office. Social distancing, hand washing, using hand sanitizer, and not sharing personal items is encouraged as well. We also sanitize our store and meeting areas. If you suspect that you have been exposed to COVID-19 or are certain you are ill with COVID 19 or another contagious illness, please do not come to in person programming until you have a negative test.
Related Linkes To check
Sources:
https://lgbtqia.ucdavis.edu/educated/pronouns (f)
https://shcs.ucdavis.edu/blog/archive/why-pronouns-are-important 
https://www.genderspectrum.org/quick-links/understanding-gender/ (g/h)
https://www.cbsnews.com/news/transgender-gender-identity-terms-glossary/ (g)
http://thepbhscloset.weebly.com/a-list-of-genders--sexualities-and-their-definitions.html 

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