Know Your Rights Fair Registration

Know Your Rights Fair Registration Form

Please complete this form to sign up for the KYR fair on Saturday January 18, 2025.
Name/Nom*

First Name/PrénomLast Name/Nom de famille
Date of Birth/Date de Naissance*

MonthDayYear
Date
Phone Number/Numéro de téléphone*
Please enter a valid phone number.
Email
example@example.com
Zip Code/Code postal*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Language/Langue préférée*
(french, english, ewe, fon, yoruba, igbo, haussa etc..)
If you are eligible for a gift card, how would you like to receive it?*

Physical card - I will pick up my cardElectronic (make sure to provide us your email address for delivery)
Gender*

FemaleMaleNon BinaryPrefer not to say
What's your Race/Ethnicity?*

Black/African/Caribbean/African AmericanAsianHispanic/LatinxAmerican IndianAlaska NativeHawaiianWhitePrefer not to say
What do you need support with? (Select all that apply)*

Registering for COVID Financial Support ProgramApplying for SNAP/Link CardApplying for Health InsuranceApplying for CitizenshipGetting information about UAO Immigration servicesGetting Moms & Baby supplies (diapers, wipes, etc.)Other

What questions or concerns would you like to address at the event? / Quelles questions ou préoccupations souhaiteriez-vous aborder lors de l’événement?
Should be Empty:

	Size 1-2 (8-18 lbs)	Size 3 (16-28 lbs)	Size 4 or Pull-Ups 2t/3t (22-37 lbs)	Size 5 or Pull-Ups 3T/4T (27+ lbs)	Size 6 or Pull-Ups 4T/5T (35+ lbs)
Child 1
Child 2

Know Your Rights Fair Registration Form