Consent Convergence Participant Registration
We're excited that you're interested in joining us for this awesome day of connecting, building skills, and taking action to create a culture of Consent!

We would love to have you there for the whole day, but if you can only come for part of it, that's ok too!

Email address *
What's your name? *
Your answer
What school and/or organization are you part of?
Your answer
We would like to sort participants into OPTIONAL Homebase Groups who you can get to know and share a table with during breakfast, lunch, and throughout the day. Please check UP TO 4 categories that you might like to gather with others who share this common interest.
Are you coming with a particular adult, friend, or crew you want to try to stick with? If so, please enter their full name(s) here.
Your answer
What is your gender? Please check all that apply.
If your gender is not listed above, please feel welcome to share how you identify:
Your answer
What is your sexual orientation? Check all that apply.
If your sexual orientation is not listed above, please feel welcome to share how you identify:
Your answer
What is your race? Please check all that apply.
If your race is not listed above, please feel welcome to share how you identify:
Your answer
Accommodations:
This is our current rough schedule of the day:

9:15: ARRIVAL // LIGHT BREAKFAST

10:00: INTRODUCTIONS // WELCOMING

10:45: WORKSHOP SLOT #1

NOON: COMMUNITY LUNCH

1:00: WORKSHOP SLOT #2

2:15: ACTION STEP PLANNING WITH HOME GROUP

3:00: WORKSHOP SLOT #3

4:00: WRAP-UP //LOOKING TO THE FUTURE

How much of the Convergence will you be able to attend? *
Will you be joining us for FREE catered lunch? GF and vegan options are available. Do you have any food allergies or dietary restrictions?
Your answer
Do you have any medical allergies or other sensitivities we should know about in case something comes up?
Your answer
Please share the name and phone number of an adult who we can contact in case of an emergency. *
Your answer
We would like to try to make the Consent Convergence as accessible as possible to everyone. What accommodations will make this event more accessible to you?
Your answer
What is YOUR phone number so we can text you if there are important changes or updates about the Convergence?
Your answer
We will send you a couple e-mails to give you all the info you need to get ready to come to the Convergence. Do you want us to also send the info to a parent/adult? If so, enter their e-mail address here:
Your answer
At the time of the Consent Convergence, my age will be: *
If you are 20 or older, you are above the age of participation.
If you would like to help out or if you plan to be present at the event to accompany specific youth(s) please exit this form and fill out the volunteer form instead: https://goo.gl/forms/yMT1V8SHTcoilwvB2
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