Rainbow Collective Registration Form

Rainbow Collective Registration

Please read blurb below before proceeding to fill out the form. Thank you!
The Rainbow Collective of Chester County is a vibrant partnership between the LGBT Equality Alliance of Chester County and Planned Parenthood Southeastern PA.

Our meetings are primarily for LGBTQIA+ identifying youth ages 14-18 and facilitated by Planned Parenthood Southeastern PA staff alongside trained volunteers. Our purpose for starting these groups was to create an environment where LGBTQ+ young people can feel accepted and empowered, and where sexual and gender identity can be embraced without fear of violence, harassment, or judgment. During the meetings, we host activities, games, discussions, and education to stay connected and exchange resources during this time. We understand that now more than ever it is important we remain connected during these uncertain times, and foster safe spaces for LGBTQ+ youth to be their authentic selves.

There are two groups: Rainbow Collective Phoenixville and Rainbow Collective SPOT in West Chester. Each one meets twice a month, on alternating weeks; they are the same contents, just different locations and times. Youth are welcome to attend one or both locations. Specific meeting details will be provided upon registration. This form registers you to sign up for the email list that notifies you about meetings across both locations.

Please contact River, lead facilitator, with any questions or concerns at spot@ppsp.org. After registering, we will be in touch to provide additional information about the group such as time and location.

Please be assured that all information submitted through this form is always kept confidential and is solely for internal use in order to verify eligibility and security. We cannot make exceptions for omitting any required information. If you have any concerns, feel free to direct them to spot@ppsp.org.
Registrant Information
Name*

First NameLast Name
Legal Name (If different from name - for emergency reasons only)

First NameLast Name
Pronouns
Youth Email*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
What school do you go to? *
Parent or Guardian Info
Name*

First NameLast Name
Relationship to Youth*
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
We usually send program and safety details to parents or guardians, but we know that not everyone’s home situation is the same. Is it safe for us to send that information to your parent or guardian?*

Yes, it is safe to send information to my parent/guardian.No, please do not contact my parent/guardian about this program.
Do we have permission to contact your parent or guardian in the event of an emergency or other safety issues?*

YesNo
If no to the above, who can we contact in such a situation? Write the name and phone number of an alternate emergency contact in the boxes below. Please note that we must have at least one 21+ guardian to contact in such a situation in order to accept a youth into the group.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Attendance and Transportation
Arrival Method(s)*

WalkingDriven by parent/guardianDriven by someone elseYouth drives themselfOther
If the youth is being driven by someone else, please state their name and relationship to the youth
Name(s) of people authorized to pick up youth
Questions
How did you hear about the groups?*
Allergies/Dietary Restrictions | Write N/A if none*
Do you have any special or accessibility needs? | Write N/A if none*
Group Expectations

1. Respect the speaker and be mindful of the noise level

2. Participation in discussions and activities is optional but encouraged

3. Respect our space – clean up after yourselves

4. What’s said here stays here, what’s learned here leaves here; respect the confidentiality of your fellow members

5. Be inclusive and do what you can to make each other comfortable

6. Consent is required for everything, including photographs

7. Absolutely no weapons permitted in the space, including but not limited to knives, firearms, swords, or bats

8. No drugs or alcohol, including not attending groups under the influence even if consumed outside the space

9. Punctuality is expected. Please note that new attendees absolutely cannot be accepted 5 minutes past the scheduled start time of 6:30 at their first meeting
I agree to adhere to the expectations listed above and I understand that failure to do so may result in disciplinary action, including termination from group membership. *
Should be Empty:

Rainbow Collective Registration

Registrant Information

Parent or Guardian Info

If no to the above, who can we contact in such a situation? Write the name and phone number of an alternate emergency contact in the boxes below. Please note that we must have at least one 21+ guardian to contact in such a situation in order to accept a youth into the group.

Attendance and Transportation

Questions

Group Expectations