Virtual Teen Talk and Virtual Teens Bingo Registration
We are excited about the opportunity to present our Mentoring partner, NC100BW-Central Alabama Chapter and Tuscaloosa SAFE Center with you and your child. This month we will focus on the following topics:
Healthy Relationships, Dating Violence, & Human Trafficking.

We look forward to seeing you and/or your child(ren) via ZOOM on Thursday during their lunch hour. Your child is welcome to join us at the CHOICE Center on Friday for the Virtual Bingo or connect via ZOOM.

Upon receipt of this registration form, we will send the ZOOM link to the email addresses provided.

Should you have any questions, please contact CHOICE at (334) 231-7019 or email us at
Teen Talk: Thursday, February 25th 12PM to 1PM
The workshop will cover topics such as healthy relationships, dating violence and human trafficking and be facilitated by Tuscaloosa Safe Center.
Teens Bingo: Friday, February 26th 11:30AM to 1 PM
The virtual activity will test participants knowledge of the information shared during teen talk.
Clear selection
Participant's Name *
Participant's Age *
Participant's School
Participant's Grade *
Participant's Email Address
Participant's Telephone Number
Parent/Guardian's Name *
Parent/Guardian's Telephone Number *
Parent/Guardian's Email Address
Parental Consent. As the parent/guardian of the participant listed above, I agree to him/her participating in the workshop that cover topics such as healthy relationships, dating violence and human trafficking and be facilitated by Tuscaloosa Safe Center. I understand that my child's participation in the workshop is voluntary. I also know nature of the conversation and will let my child know that she or he does not have to answer any question that feels uncomfortable nor feel like she/he has to stay for its entirety. By typing your name in the field below, I UNDERSTAND AND HEREBY AGREE TO ASSUME ALL OF THE RISKS THAT MAY BEENCOUNTERED ON SAID ACTIVITIES, INCLUDING ACTIVITIES PRELIMINARY AND SUBSEQUENTTHERETO. I do, for myself and for my child, heirs, and assigns, to the fullest extent permitted by law, hereby irrevocably and unconditionally release, acquit, and forever discharge CHOICE and the their agents, employees, and volunteers from any and all liability, actions, causes of actions, claims, expenses, obligations, and damages of any nature whatsoever, which I now have or which may arise in the future, in connection with my child's participation in the described activities. Please type your name below to give consent for your child to participate in this workshop and/or activity. *
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