Crush Colon Cancer - Jr. Advocacy Program Sign-Up Form
đź“Ť Empowering Youth to Raise Awareness & Advocate for Colorectal Health

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Email *
Full Name:  *
Age *
School/Organization *
Phone Number *
Home Address *
Parent/Guardian Name (if under 18) *
Emergency Contact Name & Phone: *
Why are you interested in joining the Jr. Advocacy Program?

 *
Have you or someone you know been affected by colorectal cancer? *
How would you like to contribute? (Check all that apply) *
Required
Do you have any skills or experience that would be helpful to this program? *
I, (Parent/Guardian Name), give permission for my child, (Participant’s Name), to participate in the Crush Colon Cancer Jr. Advocacy Program. I understand that this program involves community outreach and volunteer opportunities.

Parent/Guardian Signature: ______________________ Date: _____________
 *
Agreement & Signature

By signing below, I agree to participate in the Crush Colon Cancer Jr. Advocacy Program and commit to attending events, promoting awareness, and advocating for colorectal health in my community.

Participant Signature: ______________________ Date: _____________ *
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