Youth Participant Information Form (Virtual)

Solid State Community Society

Youth Participant Information Form
Youth Participant Name

First NameLast Name
Date of Birth

MonthDayYear
MM-DD-YYYY
Youth Participant Email
example@example.com
Youth Participant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityProvince

Postal / Zip CodeCountry
Do you agree to the terms and conditions highlighted in the "cohort agreement", "participant agreement", and "community guidelines" forms?
Which cohort(s) are you involved with?
Share your social media and/or website with us! Whether it's yourself or your cohort, we want to support you virtually too.
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Signature
Youth Participant Signature
Date

MonthDayYear
Should be Empty:

Solid State Community Society