Kindraza Program pre-Registration Form

Pre-Register for Kindraza Programs

Fill out the form below to express your interest. We'll notify you as soon as program dates and details become available.
Teen Information
Teen's Name

First NameNick name or Preferred Name (if different from full name)
Birth Date

MonthDayYear
Grade*
Gender

MaleFemale
City, Province/State*

CityProvince/State
Parent/Guardian Information
Name*

First NameLast Name
Cell Number
E-mail*
example@example.com
Program of interest*
Delivery method*
What are some of your interests or hobbies?
What are your strengths or things you're proud of?
What kind of skills or experiences are you looking for in a program like this?
Why are you interested in joining the Kindraza program?
Have you ever joined a program like this before?
When are you usually available for programs or workshops?*
Is there anything else you’d like to tell us?
Informed Consent and Acknowledgement

By submitting this form, I acknowledge that the information provided will be used by Kindraza non-profit oraganization to understand my (or my child’s) interests and to notify us when future programs become available.

I understand that:

This is a pre-registration only and does not guarantee enrollment in any future program.
All information shared will be kept private and used only for communication and program planning purposes by Kindraza.
If the participant is under 18 years old, a parent or guardian’s consent is required for future participation in any live programs.
I agree that Kindraza may contact us via email or phone with updates, opportunities, or further steps related to program participation.
Confirmation

I confirm that I have read and understood the above, and I give permission for Kindraza to contact us regarding future programs.
Date*

MonthDayYear
Date
Should be Empty:

Pre-Register for Kindraza Programs

Teen Information