Youth Cafe Registration Form

Registration Form

Youth Café - Second Thursday of the month, August 14, 2025 at 5:00pm. P2P is led by Ms. Alexis Lanning, Certified Peer Specialist - Youth.
Youth Café

Open conversations in a safe space that encourages self-reflection and peer-to-peer learning, the conversations help build the Youth ThriveTM Protective and Promotive Factors.
Date you are attending

MonthDayYear
Fecha que asistirá
Full Name - YOUTH*

Primer nombre del JovenApellido del joven
What city of Carroll County, GA you live at?

CarrolltonBowdonMt. ZionRoopvilleVilla RicaWhitesburg
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Suggestions or topics you would like to be included at the Youth Café?
I Parent/Guardian , parent of Youth name give permission to participate in Youth Café. I understand that I will be responsible for my son/daughter 's transportation. In case of emergency, please contact me at Area Code Phone Number .
Signature

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If you are a parent and would like to attend Parents' Café, please register at https://bit.ly/ParentsCafe-CarrollCounty It is at the same time but located at Carroll County Family Connection, Inc., Located at 306 Bradley Street Suite B. Carrollton, GA.
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Registration Form