Teen Awareness Group

Take 5 Teen Health Workshop

The Teen Awareness Group of Hudson Headwaters will be presenting the FREE health education program for teen's ages 12-18 focusing on risk reduction and sexual health and wellness. Each workshop provides facts and information to help teens delay sexual activity; prevent unplanned pregnancy and STD/HIV infections.

The program includes lunch, snacks, educational information, and fun! Advanced registration and parental permission is required. Additional information can be found at www.teenawareness.net/events or by phone to 518-761-0300 ext. 31119!

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* 1. Which Take 5 Teen Health Workshop are you registering for?

Please let me know when the next Take 5 Teen Health Workshop is being held.

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* 2. Please provide us with the following details for the participant:

Name:

Address:

City, State, Zip Code:

Phone Number:

Email:

Age:

Grade Level:

How did you hear about the program?

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* 3. Do you have any known food, latex, or any other allergy we should be aware of?

Yes

If you answered yes, please list them.

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* 4. Pick one of the following sandwich choices for lunch:

Turkey

Ham

Veggie

This program is after school or a 2 day program & does not qualify for lunch.

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* 5. Do you give permission for your child to be included in group photos for future promotion of the group/activities?

I give permission for my child to be included in group photos.

I do not give permission for my child to be included in group photos.

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* 6. I give permission for my child to participate in the Take 5 Teen Health Workshop. I understand that it contains medically accurate information regarding reproductive & sexual health. Participation is voluntary, by virtually signing I give my permission for my teen to participate. *We will call the parent/guardian to verify registration within 3 business days.

Parent/Guardian's Signature

Parent/Guardian's Phone Number

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* 7. At the completion of the program, each participant receives a gift card.
(Participant must be present for the entire and/or both sessions to qualify for the gift card.)

iTunes

Regal Cinemas

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* 8. If you have any further questions, please contact the Teen Awareness Group of Hudson Headwaters at (518)761-0300 ext. 34682 or leave us a comment below!

Question Title

* 1. Which Take 5 Teen Health Workshop are you registering for?

Question Title

* 2. Please provide us with the following details for the participant:

Question Title

* 3. Do you have any known food, latex, or any other allergy we should be aware of?

Question Title

* 4. Pick one of the following sandwich choices for lunch:

Question Title

* 5. Do you give permission for your child to be included in group photos for future promotion of the group/activities?

Question Title

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* 7. At the completion of the program, each participant receives a gift card. (Participant must be present for the entire and/or both sessions to qualify for the gift card.)

Question Title

* 8. If you have any further questions, please contact the Teen Awareness Group of Hudson Headwaters at (518)761-0300 ext. 34682 or leave us a comment below!

* 7. At the completion of the program, each participant receives a gift card.
(Participant must be present for the entire and/or both sessions to qualify for the gift card.)