Common Ground Participant Registration

A 5-week awareness and empowerment program for female-identifying youth aged 12-18.

Weekly Topics Include:
Consent & Boundaries
Social Media
Gender Based & Dating Violence
Healthy Relationships
Human Trafficking
Safety Planning
Self-Care.

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1. Upcoming Common Ground Dates/Locations

Orillia Wednesday April 1st - April 29th

Barrie Wednesday May 20th - June 17th

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2. What Location of Common Ground are you interested in? (Required.)

Barrie

Orillia

Virtual

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3. Participant's Full Name (Required.)

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4. Participant's Date of Birth (Required.)

Date / Time

Date

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5. OPTIONAL: Preferred Pronouns

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6. Caregiver or Youth Contact Information (Required.)

Name *

Address

City/Town

Email Address *

Phone Number *

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7. Common Ground often has our facility dog(s) present. Are you comfortable with dogs? (Required.)

Yes

Unsure

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8. Please list any food allergies or dietary restrictions

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9. What is your preferred method of contact?

Phone

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10. OPTIONAL: Where did you hear about Common Ground?

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11. PLEASE NOTE: You will be contacted by a CYACSM Staff member to confirm dates, time and registration closer to our next start date for your location requested.

Common Ground Participant Registration

Question Title

* 1. Upcoming Common Ground Dates/Locations

Question Title

* 2. What Location of Common Ground are you interested in? (Required.)

Question Title

* 3. Participant's Full Name (Required.)

Question Title

* 4. Participant's Date of Birth (Required.)

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* 5. OPTIONAL: Preferred Pronouns

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* 6. Caregiver or Youth Contact Information (Required.)

Question Title

* 7. Common Ground often has our facility dog(s) present. Are you comfortable with dogs? (Required.)

Question Title

* 8. Please list any food allergies or dietary restrictions

Question Title

* 9. What is your preferred method of contact?

Question Title

* 10. OPTIONAL: Where did you hear about Common Ground?

Question Title

* 11. PLEASE NOTE: You will be contacted by a CYACSM Staff member to confirm dates, time and registration closer to our next start date for your location requested.

1. Upcoming Common Ground Dates/Locations

2. What Location of Common Ground are you interested in? (Required.)

3. Participant's Full Name (Required.)

4. Participant's Date of Birth (Required.)

5. OPTIONAL: Preferred Pronouns

6. Caregiver or Youth Contact Information (Required.)

7. Common Ground often has our facility dog(s) present. Are you comfortable with dogs? (Required.)

8. Please list any food allergies or dietary restrictions

9. What is your preferred method of contact?

10. OPTIONAL: Where did you hear about Common Ground?

11. PLEASE NOTE: You will be contacted by a CYACSM Staff member to confirm dates, time and registration closer to our next start date for your location requested.