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LGBTQ+ Youth Sanctuary registration
Welcome to Youth Sanctuary
Please fill out this brief questionnaire for the safety of everyone involved
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* Indicates required question
Email
*
Your email
What is your/their preferred name?
*
Your answer
What are your/their pronouns?
Your answer
What is your/their birthday?
*
MM
/
DD
/
YYYY
Are there any allergies we need to be aware of?
Your answer
Are there any dietary restrictions we need to know about?
Your answer
Do they have any special needs or requests that we can accommodate?
Your answer
Please indicate whether or not we may use your/their image on our website and/or social media. (Names of the children will NEVER be shared.)
*
No, I DO NOT give permission
Yes, I DO give permission
What are you/they looking for from this experience?
Your answer
Where did you hear about us?
*
Social Media (FXBG Pride)
Social Media (UUFF)
Website (FXBG Pride)
Website (UUFF)
Word of Mouth/ Friend or Family
Flyer/Card posted
Other:
Safe Adult information
In the event someone needs to be called for any reason
(including medical emergencies)
, this is the person you/they feel most comfortable with
Name (1)
*
Your answer
Email
*
Your answer
Phone
Your answer
Relationship
*
Your answer
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