LiFT Workshop Registration

In collaboration with:

Greene County Boys & Girls Club &

Greene County Family Connections

Saturday, October 26th AND Saturday, November 2nd

10am-1pm

*Must attend both sessions*

Pete Nance Boys & Girls Club

1471 MLK Jr Drive

Greensboro, GA 30642

*IMPORTANT NOTE: Please complete 1 Registration Form per Family*

The Demographic Questions are for the person completing the form.

Thank you for registering for GCAPP's LiFT Workshop!

LiFT is a 6-hour workshop (broken down into two 3-hour long sessions) for youth and their parents/caregivers/trusted adults to learn healthy communication skills. This workshop is made for families only, including youth and their trusted adult. Registering for this workshop means that at least 1 youth and 1 adult will be attending the workshop.

Please complete the registration form below so that we know how many people plan to attend our workshop.

To better service our communities, GCAPP collects the following demographic information. Your decision to share personal information is entirely voluntary; if you choose not to share there will be no penalty or consequences and you will still have full access to GCAPP's services and resources.

All information you share is kept confidential to the full extent allowed by law. All data is secured within GCAPP’s database accessible only to GCAPP’s Senior Leadership Team.

First Name (of person completing form)

Last Name (of person completing form)

Contact Information (of person completing form)

Phone #

How many total people (including person completing form) will be attending the workshop? (Please select all that apply) Note: You must register at least 1 youth AND 1 adult to attend this workshop

Please describe:

Youth/Young Adult Participant Information

Are you a GCAPP Youth Advisory Council (YAC) Member?

YesNo

Do you, or anybody that is attending the workshop with you, have any food allergies or dietary restrictions?

YesNo

Please list all food allergies or dietary restrictions below:

Demographic Information of Person Completing Form

Race

Race Not Listed

Are you hispanic, latino, or latinx?

Gender

Gender Not Listed

Personal Pronoun

Pronoun Not Listed

Sexual Orientation

Orientation Not Listed

County of Residence

Your Consent

Please read this entire message and select 'YES' to indicate that you understand the above and agree to participate in this program.

We invite your child to participate in the LiFT Workshop. This program empowers young people to be safe and make healthy life choices. We also seek to reduce teen pregnancy and STD rates while promoting responsible adolescence.

Confidentiality: No information collected about your child will be shared in materials or reports produced about the program. We will keep all personal information about your child confidential. Also, our staff are mandated reporters and must report any information about a youth that is of a concerning nature.

Risks: Your child's participation in this program poses few, if any, risks to them. Your child's participation is entirely voluntary. Your child may end participation at any time and for any reason. If your child withdraws from the program, it will have no impact on any services.

Time Commitment: Your child will spend a total of six (6) hours in the LiFT workshop. Attendance information will be collected and certain class sessions may be observed for quality. Your child may be invited to discuss their experience in the program along with other youth.

Allergies: Please share any food or materials allergies that your child has. GCAPP is not responsible for any allergic reactions to food or materials ingested or handled during while participating (when safe, in-person) in this program.

Benefits: Your child will receive a token of appreciation for time spent participating.

Contact information: If you or your child has any concerns about participation in this program, please contact Shay Ross, Program Manager, at Quashavis@gcapp.org.

Please select 'YES' to indicate that you understand the above and agree that your child can participate in this program.

This workshop is for youth (ages 13-19) and their trusted adult. Registering for this workshop means that at least 1 youth and 1 adult will be attending the workshop. Please select confirm that you acknowledge and understand the purpose this workshop below.

I acknowledge and understand the purpose of this workshop

Contact Information