Youth Hangout Membership Enrollment

Thank you for your interest in attending Youth Hangouts at the Shared Spaces.

Below we ask basic information to register your youth as become a member of the youth collective and enroll them for the experiences offered at the Shared Spaces, including Youth Hangouts.

We also ask for some thoughts and insight into what they are hoping to experience from Youth Hangouts and if there are ways you feel we can help them with our community-based group mentoring programming (ie: Youth Hangouts) and Adult Ally support.

At the end it will ask for your consent, with a link to the full consent found here and at the end of the form. If you have additional questions or would prefer to chat more with us, there is a space to let us know that and we are happy to answer any questions you might have about the program.

We look forward to having your youth join us and being a part of their #CircleOfSupport 🙂

Youth Info
Name*
First Last
Preferred Name:
How does your youth identify (male, female, transgender, two-spirited, etc.):
What pronouns do they prefer [Ex: she/her | he/him | they/them]:
Birthdate:*
MM slash DD slash YYYY
School Attending:
School (if not listed above):
Grade:
Home Address:
Do you (the youth) have any food allergies we need to be aware of?:
What interests you (the youth) the most about Youth Hangouts or the Shared Spaces? Is there anything you hope to experience or do?
Parent | Guardian | Supportive Adult Info
Name*
First Last
Contact Number:*
Contact Email:*
Relationship to the Youth (ie: Mom, Dad, Grandparent, etc):*
Are you the emergency contact you want listed?*
- Yes I am
- No, I am listing someone else below
Other Emergency Contact (Name, Contact Number, Relationship to the Youth):
How do you think your youth will benefit from Youth Hangouts or the Shared Spaces? Is there something specific you feel we can help them with?
Would you like to be added to our contact list to stay in the know for future youth events, activities, and opportunities?
- Definitely!
- No thanks!
I agree to consent to my youth attending Youth Hangouts and other programming offered at the Shared Spaces.*
- Yes
- No
- I would like to chat further with the Program Lead and sign in-person
For more information and details please visit the full Informed Consent PDF available at: https://battlefords.bigbrothersbigsisters.ca/wp-content/uploads/sites/171/2024/09/Informed-Consent-Site-Based-Group.pdf
Digital Signature (Parent/Guardian Name):*
Date*
MM slash DD slash YYYY
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Youth Hangout Membership Enrollment

Youth Info

Parent | Guardian | Supportive Adult Info