New Participant Registration Form
Classy Chick Chat – Program Registration
Participant Details:
Are you completing this form as:
*
Please Select
A parent or guardian of a participant under 18
A participant age 18–24
Participant's Name
*
First Name
Last Name
Participant's Age
*
Participant's Grade Level
*
Please Select
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
College
School Name (if applicable)
Parent/Guardian Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Format: (000) 000-0000.
Which program(s) are you interested in?
*
Fearless Leaders Mentorship & Career Prep
Real Talk & Wellness Series
Purpose & Financial Empowerment
Summer Empowerment & Enrichment
Conferences & Special Events
What areas would you like to grow in or receive support in?
*
Confidence & self-esteem
Communication & leadership
Emotional wellness & resilience
Goal-setting & decision-making
Financial awareness
Healthy relationships
Does the participant have any needs or accommodations we should be aware of?
How did you hear about Classy Chick Chat?
*
Please Select
School
Parent or caregiver
Friend or peer
Social media (Instagram, Facebook, TikTok, etc.)
Community organization
Church or youth group
Event or conference
Online search
Other
Consent & Safety
*
Please Select
For Parents of Minors: I give permission for my child to participate in Classy Chick Chat programs.
For Ages 18–24: I confirm that I am 18 years or older and consent to participate in Classy Chick Chat programs.
Submit
Should be Empty: