October 25, 2025 Match Event Youth Registration Form

October 25, 2025 Match Event Youth Registration Form
Date: October 25, 2025

Time: 9:30 AM - 3:30 PM

Location: Central Pennsylvania - Harrisburg Region

We look forward to seeing you in October!

Please complete the entire form. You will be notified when your registration has been accepted. Location address and directions to be disclosed at that time.
Youth's Name*

First NameLast Name
Youth cannot be publicly identified and uses an alias

NoYes
Youth's Alias
Only if youth cannot be publicly identified.
Youth's Birthday*

MonthDayYear
Date
Youth's PAE#*
Does the Youth have a chronic condition, disability, dietary restrictions or food allergies?*
Please explain any accommodations Youth requires.
Worker Name*

First NameLast Name
Worker Email*
example@example.com
Worker Phone Number*
Please enter a valid phone number.
Agency*
Who Will Be Attending With Child*
Legal Representative For Release Of Photography Request*

First NameLast Name
Email Address For Releases For Youth Photography At Event*
example@example.com
Is the Youth exploring any families right now in any capacity?

YesNo
Meet The Youth Booklet
The answers to the following questions and the photo submitted will be used to make our Meet the Youth Booklet. This booklet will serve as a reference for the families to remember the youth when inquiring at the end of the event.
Fun Fact #1*
Fun Fact #2*
Fun Fact #3*
The youth would do great in a home that... *

Brief Answer: 30-100 words0/100
Youth Photo*

Headshot showing youth's face preferred. Non-identifying photo acceptable
Cancelof
Demographic Information

The demographic information you provide Adoption Center is very important. Adoption Center respects an individual’s right to keep certain personal information private. Any information provided will be used solely for the important purposes of improving our service offerings and fundraising. We will not sell, trade, or transfer an individual’s personal demographic information to any third party or entity. If you have any questions or concerns regarding the information you provide in this survey, please contact us at mediarecruitment@adopt.org. Thank you.
Youth's Gender Identity
Is Youth part of LGBTQ+ community?
What is Youth's ethnicity or racial background?

African American or BlackAsian/Pacific IslanderHispanic/LatinoCaucasian/WhiteNative AmericanOther
Should be Empty:

October 25, 2025 Match Event Youth Registration Form

Meet The Youth Booklet

Demographic Information