NOR CALI OSAWRAP R4L REGISTRATION

OSAWRAP NOR CAL EDITION

Welcome to OSAWRAP Ready4Life Northern California! Please fill out registration below.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

City

Zip Code
Phone Number*
Please enter a valid phone number.
Do we have permission to text you?*

YesNo
Email*
example@example.com
Preferred Method of Contact

Phone CallTextEmail
Date of Birth*

MonthDayYear
Date
Age*
Grade Level
Gender*

MaleFemaleOther
What is your race/ethnicity?*

Black/African-AmericanWhite/CaucasianNative Hawaiian/Pacific IslanderNative American/Alaskan NativeAsian AmericanHispanic/LatinoOther
What is your T-shirt size?*

SmallMediumLargeXL2XL3XL
How did you hear about us?*

OSAWRAP Social MediaTitle VOutreach Event/Employment FairParents/GuardiansFriendOther
Emergency Contact
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Are you in need of the following services...*

Food PantryDomestic Violence ResourcesOther: Housing, Health Insurance, Social ServicesDo not need any resources/services
What workshop would you like to register for:*

Virtual Zoom WorkshopIn-Person WorkshopOther
What program are you a part of ? (Partner Confirmation Required)*

Camp UnityPolynesian SisterhoodStag EliteCordova High SchoolEmployment Fair/Outreach EventOther
Terms of Workshop and Incentive - Participants must be 14-24 year old California residents, with a validated phone number and email. Upon completion, gift card incentives will be distributed within two weeks of workshop conclusion unless otherwise updated. Incentives will be distributed based on in-person or online workshop at the discretion of OSAWRAP. OSAWRAP Ready4Life reserves the right to withhold any gift card incentive upon suspicion of false participant information.
Please verify that you are human*
Should be Empty:

OSAWRAP NOR CAL EDITION

Emergency Contact