YouthSAFE Sign-in Form
Thank you for completing this form! We will only use the information you provide here in the case of emergency.
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What is the date of the YouthSAFE meeting you are attending? *
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DD
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What is your preferred name? *
What are your pronouns? (pick as many as apply) *
Required
What is your legal name? (first and last) -- We will only use this information if medically necessary. *
What is your birthday? (We will only use this information in the case of a medical emergency) *
MM
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DD
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YYYY
What is a good phone number to reach you? *
Please list the name of your parent or legal guardian we can contact in the case of emergency. *
What is this adult's relationship to you? *
What is this adult's phone number? *
Does this adult know that you attend YouthSAFE meetings? *
Is there anything we should know to preserve your privacy in the case we need to reach out to your emergency contact?
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