OCMI REVERSE MATCHING EVENT
Forms will be considered complete when all the required information is submitted, and accepted on a first come basis. Workers must accompany and stay with the youth to the event. Please identity the person bringing the youth to the event. Event registration is limited to 20 youth. If a youth is unable to attend please let us know ASAP so the spot can be filled by another available youth. A confirmation email will be send when your youth is successfully registered. Any registration questions can be sent to Todd Kline - tkline@familypathways.net
Youth Name
*
First Name
Last Name
Youth Alias
*
Date of Birth
*
PAE #
*
Youth Flyer (must be uploaded before registration is complete)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Youth's county
*
Worker Name
*
First Name
Last Name
Worker Name (if other then the registering worker or N/A)
*
First Name
Last Name
Worker's Agency
*
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Additional Information (dietary restrictions, etc.)
Submit
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