Newcomer 2SLGBTQ+ Peer Support Group: Sign-up Form
This virtual group is for youth living in Stratford-Perth County and Waterloo Region, an will occur every Wednesday from 3:30-4:30pm during July and August (July 6 to August 31). Participants can range from those who are entering Grade 9 in September 2022 to those who graduated High School in June 2022. Please contact Beck Mallozzi at rebecca.mallozzi@ytr.ymca.ca or 226-808-7358 if you would like any further information. Register below to join as many sessions as you’d like!
Legal Name
*
First Name
Last Name
Preferred Name
Pronouns
ex. she/her, he/they, ze/zir, etc.
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Birthday
*
-
Month
-
Day
Year
Date
Immigration Status
*
Canadian Citizen
Permanent Resident
Temporary Resident
Convention Refugee
Other
How did you hear about this group?
*
Do you have any specific topics that you would you like to talk about?
Ex. 2SLGBTQ+ characters in media, personal experiences, etc.
Do you have any concerns or additional needs that you'd like to share with me?
Submit
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