Youth Coalition Registration

Youth Coalition Registration

September 24, 2026. 4:00 - 5:00 P.M. ~ Location: 1515 E 20th St. #B, Farmington, NM
Contact Info:

Selece Gathings — gathingss@sjcpartnership.org — 505.360.9624

Thomalisa Yazzie — yazziet@sjcpartnership.org — 505.565.5143
Youth's Full Name

First NameLast Name
Youth's Age
Youth's Email Address
example@example.com
Youth's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Full Name

First NameLast Name
Parent/Guardian Email Address
example@example.com
School
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Should be Empty: