Queen Charlotte Youth Centre - Registration Question Title * 1. Parent/guardian name(s): Question Title * 2. Parent/guardian email(s): Question Title * 3. Emergency contact phone number: Question Title * 4. Youth name(s) and birth dates Question Title * 5. Home address (for care package delivery) Question Title * 6. Another home address? (if applicable) Question Title * 7. PO Box (for potential prize delivery) Question Title * 8. What would you (and/or your child) be interested in seeing from the Youth Centre? Care packages Virtual art/culture/music workshops Virtual yoga/movement/wellness workshops Hiking / camping / field trips Local food harvesting / gardening opportunities Haida language materials/activities Ideas/resources for home-based activities Special activity day-camps (eg. skateboard, dance, craft, nature, juggle) Virtual book club Teen mental health support/resources/programming Teen activism / social justice engagement Opportunities for parents or youth to volunteer Other (please specify) Question Title * 9. The Queen Charlotte Youth Centre will keep all of your information private. Do you give consent for us to use pictures of your child(ren) for communication/promotion purposes? Yes No Done