Marrow Enrollment
Marrow programming and enrollment is for youth 10-24 only! Thanks!
We require everyone to enroll with us, both for your safety, and also to collect basic information about attendance for our funders. If you have an issue, please send an email to daylynn@marrowpdx.org or come by the space!
ONLY the program director (Daylynn) will see this form.

(Enrollment is three pages, the second page is a safe(r) space contract, the third page is an optional survey.)

Your age: *
(Enrollment at Marrow is for youth 10-24 only).
INFO ABOUT YOU:
Your legal name: *
(first and last) (if you don't go by your legal name, no worries - it's for emergencies only)
Your answer
What we should call you:
(if it's something other than your legal name)
Your answer
Your pronouns: *
(check any that apply, or write them in)
Required
Your birthday: *
(Please be sure to put your birth year, not 2018)
MM
/
DD
/
YYYY
Your email address: *
Your answer
Your phone number: *
Your answer
Is it okay for us to contact you? *
(check any that apply)
Required
May we post photos and videos of you (taken at Marrow) to our social media/website/other media (like flyers)? *
(if you don't like something we post, we will always take it down!)
How did you find out about Marrow? *
Is there anything else you'd like us to know about you?
(if so, here's your space to do so! special needs, interests, concerns, etc)
Your answer
EMERGENCY CONTACT INFO:
(someone we can contact if there's an emergency that involves you. if you're under 18 years old this should be someone who is 18+, preferably a parent or other adult you trust.)
Their name: *
Your answer
Their phone number: *
Your answer
Their email address: *
Your answer
ENROLLMENT
There are more in-depth descriptions of the two options here: http://www.marrowpdx.org/enroll/
How would you like to enroll? *
If you selected "SEASONAL", and someone other than you will be paying, please give us that person's email address here:
Your answer
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