MGC Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for participating in our Mentoring Girls of Color Restoration Retreat (MGC). We look forward to seeing you on May 4th, 2024 from 8 AM - 4 PM in Upland, California. Breakfast and Lunch included. We want to collect some information from you to make sure your experience is an unforgettable one filled with fun, connecting and healing. Please answer the questions below.

Please use this SmartWaiver Permission Slip to give authorization for photos and videos, as well as guardian permission for youth under 18. Everyone attending does need to complete the permission slip. Thank you!

Drop off and Pick up will happen at this address: Pioneer Junior High School

245 W. 18th St. Upland, CA. 91784. All mentors and mentees will be shuttled to the youth power hub.

Watch Our SPECIAL INVITE to the Mentoring Girls of Color Restoration Retreat

First Name *

Last Name *

Home Address *

Email Address *

Age *

13-18 Years Old

19 +

Pronouns *

She/Her

They/Them

Non-Binary

Other

Please Share Instagram Handle

Please Share Tik Tok Handle

Dietary Restrictions *

Vegan

Vegetarian

Gluten Free

Other

None

What food allergies, if any, do you have? *

Tell us about...

You? Your likes? What gets you excited? How we can support you best?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of MENTOR California. Report Abuse

Forms