Project Bloom Registration Form - Aug. 1st - 8th
Welcome to Project Bloom presented by the Earthlodge Center for Transformation! We are so excited to have you. Please answer the following questions so we can create the best programming possible for you.
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Email *
Name of Youth *
Parent or Guardian Name *
Full Address Zip Code Required *
Phone Number *
Email Address *
Emergency Contact - Name and Phone Number *
Age *
Ethnicity *
Gender Identity *
What interests you about the program? (1-5 sentences) *
Will you be able to attend all of scheduled session of the program? If not, which days will you miss? *
Do you or your youth have any food allergies? Please specify. *
Do you or your youth have any mobility issues or access needs? Please specify. *
Please keep a lookout for our Consent form and our Media Release Form, which will be required in order to attend the program. Thank you and we cannot wait to see you at the Earthlodge!
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