Block Champion Registration Form

BLOCK CHAMPION Registration Form

Complete the form with your contact details, availability, interests, and required consents to confirm your spot for community events.
Boston Square Block Champion Application
Basic Information
Full Name

First NameLast Name
Preferred Name
Email Address
We’ll use this to contact you about the Block Champion network.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred method of contact
How long have you lived in Boston Square?
Example: 3 years
Are you a homeowner, renter, landlord, or business owner?

Other
Your Block
What is your street/block?
What is the nearest cross street?
Approximately how many households are on your block?
Do you already know your neighbors?
Is there already an informal block group or neighborhood network on your block?
Are there particular concerns or opportunities affecting your block?
Why Become a Block Champion?
Why are you interested in becoming a Boston Square Block Champion?
What would you most like to help accomplish on your block?
What do you think would make your block stronger, safer, and more connected?
Areas of Interest
What would you like to help with?
Capacity & Communication
How often would you realistically be able to participate?
Would you be willing to:
Community Connections
What skills, experience, relationships, or resources would you bring to the Block Champion network?
Examples: organizing, communications, youth engagement, gardening, construction, social media, event planning, business connections, neighborhood history, etc.
One Big Question
If you could change one thing about your block or the Boston Square neighborhood over the next year, what would it be?
Final Commitment
As a Boston Square Block Champion, I understand that my role is to help strengthen communication, connection, and collective action among neighbors—not to represent the views of every person on my block.
Agreement
What best describes you?
Electronic Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

BLOCK CHAMPION Registration Form

Boston Square Block Champion Application

Basic Information

Your Block

Why Become a Block Champion?

Areas of Interest

Capacity & Communication

Community Connections

One Big Question

Final Commitment