Application Form
CONTACT & HEALTH INFORMATION
First Name
Your answer
Last Name
Your answer
Preferred Name
Your answer
Preferred Pronoun
Age
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Your answer
Personal cell phone number
Your answer
Email address
Your answer
Mailing Address
Your answer
Parent/guardian Full Name
If you are under 18.
Your answer
Parent/guardian Phone Number
If you are under 18.
Your answer
Parent/guardian Email
If you are under 18.
Your answer
Emergency Contact - First and Last Name
If you are under 18, we will contact your parent/guardian first. Please list a second emergency contact person.
Your answer
Emergency Contact - Phone Number
If you are under 18, we will contact your parent/guardian first. Please list a second emergency contact person.
Your answer
Please list your dietary needs and all allergies that you have.
If you do not have any dietary restrictions or allergies, just write N/A.
Your answer
Do you have any physical, emotional, or mental health considerations that we should know about?
Please note, this information will be kept confidential and will not affect our selection process. We just want to make sure that we can provide you with a safe and supportive experience. If you do not have any health issues, just write N/A.
Your answer
GETTING TO KNOW YOU
Reel Youth is committed to offering our programs to a diverse group of participants. How would you best describe your cultural or ethnic background?
Your answer
Why do you want to join this program?
Your answer
What unique life experiences do you bring to this program?
This program is a safe space for youth of all gender identities, and socio-economic, cultural, and family backgrounds, and is intended to be an accessible opportunity for people who have faced or are facing challenges. Please be specific and creative in your response! It will play a large part in our selection.
Your answer
Will you be able to attend all program sessions?
Aug 26-30 (11am - 5pm each day)
Required
Have you participated in a Reel Youth program? before?
Required
If yes, which program and where?
Your answer
In order to participate in the program you will need to sign a media release form.
Required
How did you hear about this program? Be specific!
Your answer
Thank you for your application!
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