• Teen Work & Wellness Tuesdays @ the Hub Sign-up Form

  • INTRODUCTION

  • Make Tuesday worth your time! Join Butterfly Dreamz + Flourish Community Hub for hands-on community projects, connection, and skill-building in Gary, IN.

    • For high school students. Tuesdays, October 27–December 22, 5–6:30 p.m., plus optional Saturday sessions on November 14 and 21, 11 a.m.–2 p.m.
    • You only need to sign up once. Select the dates you currently plan to attend. If your plans change, contact Ms. Michaela Dennie at michaela@rootedresearch.group rather than submitting a new form.
    • If you're under 18, your parent or guardian must complete and sign the permission section. Please complete the form together.

  • ABOUT YOU

  • Format: (000) 000-0000.
  • Can you receive text messages on this phone number?*
  • Student's Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you under 18 today?*
  • Current Grade*
  • Where is your high school or GED/HSE program located?*
  • What pronouns do you use?*
  • How do you describe your gender?*
  • How do you describe your race and/or ethnicity? Please select all that apply.*

  • YOUR PLANS

  • Which sessions do you currently plan to attend?*

  • For participating in the sessions, you can choose a $20 stipend OR documented volunteer hours. The question below tells us your current preference; however, you can let the program team know if you'd like to change it. Also, please keep in mind that if you arrive more than 15 minutes late, you will only be eligible for documented volunteer hours.

  • Which participation option are you interested in?*

  • PHOTO/VIDEO RELEASE

  • During Teen Work & Wellness Tuesdays @ the Hub and related program activities, Butterfly Dreamz, Inc. may take photographs and record video or audio of you. These photographs, videos, electronic images, and recordings may be used by Butterfly Dreamz, Inc., its assigns or successors for public relations and publicity purposes, including websites, social media, and printed materials. These photographs and recordings will be the property of Butterfly Dreamz, Inc.

  • PARENT/GUARDIAN PERMISSION

  • Parent or guardian: Please complete this section yourself. Enter your contact information, review the permission statements, and provide your electronic signature.

  • Format: (000) 000-0000.
  • Can you receive text messages on this number?*
  • Participation permission:*

  • Parent/Guardian Photo/Video Consent
    During Teen Work & Wellness Tuesdays @ the Hub and related program activities, Butterfly Dreamz, Inc. may take photographs and record video or audio of the student named in this form. These photographs, videos, electronic images, and recordings may be used by Butterfly Dreamz, Inc., its assigns or successors for public relations and publicity purposes, including websites, social media, and printed materials. These photographs and recordings will be the property of Butterfly Dreamz, Inc.

  • Should be Empty: