Generation Hope Bridge Nights Registration Form
Generation Hope Bridge Nights is a weekly time for teens and young adults, 15-25 years of age, to meet with peers, talk about relevant life topics and hear from adult leaders who are trained or experts on the topics the group chooses to discuss.
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
Participant's Email
example@example.com
Participant's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Does the participant have any allergies, medical conditions, or special needs? If yes, please specify.
If participant is under the age of 18, a parent or guardian must provide consent to participate.
Parent/Guardian Full Name (if applicable)
First Name
Last Name
Parent/Guardian Relationship to Teen
Please Select
Mother
Father
Legal Guardian
Other
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Parent/Guardian Acknowledgment - If under the age of 18:
Parent/Guardian Consent - If under the age of 18:
Is anyone other than the parent/guardian authorized to pick up the teen? If yes, please provide their name(s) and relationship.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
I allow photos/videos to be taken of my teen/myself during the program to be shared on Bridge Point's social media/website.
I give my consent
I do not give my consent
Participant OR Parent/Guardian Signature
*
Submit Form
Submit Form
Should be Empty: