Youth YA Registery

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* 1. What is your name?

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* 2. Where are you from?

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* 3. What is your age group?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 4. Help us get to know you better- what do you like to do on your spare time?

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* 5. Have you been to a Youth and Young Adults group before?

Yes

No

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* 6. If you did, did you enjoy it? If not tell us why and what you hope for it to be.

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* 7. Anything specific we should know? Conditions, food allergies, etc?

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* 8. What time of the day works best for you?

Early

Mid Day

Late

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* 9. What is the best number to contact you?