Marrow Enrollment
We require everyone 10-24 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:
Name you go by (FIRST & LAST): *
Your answer
Your legal name (FIRST & LAST):
If different from the name you go by, listed above. (We will NEVER deadname you. This goes into a collapsed column in our spreadsheet and will be looked at in case of emergency only.)
Your answer
Your pronouns: *
(check any that apply, or write them in)
Required
Your birthday: *
(Please be sure to put your BIRTH YEAR, not the current year!)
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
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