Green Guardians Environmental Stewards Program

Green Guardians Environmental Stewards Program — Youth Registration

Green Guardians is a youth leadership, environmental stewardship, workforce development, community wellness, and civic engagement program. Participants will take part in hands-on environmental projects, leadership development, workforce readiness activities, community beautification, mentorship with firefighters and community professionals, and the creation of green spaces throughout Cincinnati. Enrollment is limited to 25 youth participants ages 10-21.
Youth Participant Information
Full Legal Name

First NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Gender

Other
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
School Name
Current Grade
Youth Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Youth Email Address
example@example.com
T-Shirt Size
Neighborhood / Community
Parent/Guardian Information
Parent/Guardian Full Name

First NameLast Name
Relationship to Youth
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address (if different from youth)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Method of Communication
Is there a second parent/guardian who should receive program communications?
Emergency Contact
Emergency Contact Name

First NameMiddle NameLast Name
Relationship to Youth
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Health, Safety & Accessibility Information
Does the child have any allergies?
If yes, please describe the allergies and any known reactions
Does the child have any medical, dietary, physical, accessibility, or other needs staff should know about to support participation?
If yes, please describe the needs and any helpful support information
Does the child require any medications during program activities?
If yes, please list the medication details and any instructions staff should follow
Are there any activity restrictions staff should know about?
If yes, please describe the restrictions and any recommended alternatives
Anything else staff should know to help the child participate successfully
Emergency medical authorization
Youth Interests & Program Goals
Why is the youth interested in joining Green Guardians?
What does the youth hope to learn or gain from this program?
Areas of interest

Other
Has the youth participated in any community service, leadership, gardening, environmental, or youth development programs before?
If yes, please briefly describe those experiences and any careers or professions the youth is currently interested in exploring.
Participation & Attendance Commitment
Green Guardians is a multi-session youth development program that includes leadership and workforce development sessions, environmental projects, community beautification activities, firefighter mentorship, Green Guardians Community Day, and a graduation/recognition ceremony.
Attendance Acknowledgment
Parent/Guardian Acknowledgment Signature
Media Release & Transportation (Parent/Guardian Consent)
Media, Photo, Video, and Work Release
Transportation Consent for Program Activities
Parent/Guardian Consent & Signature
Consent Statement
Parent/Guardian Full Name

First NameMiddle NameLast Name
Date

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

Green Guardians Environmental Stewards Program — Youth Registration

Youth Participant Information

Parent/Guardian Information

Emergency Contact

Health, Safety & Accessibility Information

Youth Interests & Program Goals

Participation & Attendance Commitment

Media Release & Transportation (Parent/Guardian Consent)

Parent/Guardian Consent & Signature