Virtual Session- Sat. February 22nd 11:00am EST
Via Zoom
Name
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First Name
Last Name
Phone Number
*
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Area Code
Phone Number
E-mail
*
City of Residence?
*
Age of Participant
*
During this virtual session, Participating on camera is Required. I understand that any personal information disclosed will be held confidential by Shekita Jackson/Care for Me Youth Initiatives/volunteers & staff/Briana Perry-Hurst, unless there is immediate danger. The Zoom link will be emailed out prior to the session
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