STRIPES - An online space for LGBTQ+ youth ages 11-13 to connect with their peers and get support in Shasta and surrounding counties.

**Your parent must register you and check in by phone before you're allowed to participate."

STRIPES is fun and supportive group for middle school age LGBTQ+ youth (11-13) living in far rural NorCal.

This group takes place from 6:00 - 7:00 p.m. on Thursdays on Go To Meeting.

Please tell us a little about a yourself by answering the questions below. You will be emailed instructions before the group starts on how to join the go to meeting.

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* 1. Parent's full name.

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* 2. Child's full name.

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* 3. Child's pronouns (she/her, he/him, they/them)

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* 4. Parent phone number.

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* 5. Parent email.

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* 6. We realize that these next few bits sound a tad bossy, but these agreements help create a safer online environment. Read and check each box:

I understand that this is a group that affirms a person's LGBTQ+ identity and helps people to live their truest most authentic lives. That being LGBTQ+ is a normal part of being a whole person and LGBTQ+ people should be able to embrace their identity without shame, pressure to change or repression of this part of their being.

I understand that NorCal OUTreach Project takes measures to make safety in this online space a priority. Everyone who wishes to participate in this group is required to RSVP either through this online for or by phone, which helps us screen attendees. However, we cannot guarantee complete privacy from people who do not come to us with the best of intentions. I understand it is my responsibility to read the Go To Meeting Privacy Policy for details on how Go To Meeting collects and shares information and to contact Go To Meeting directly if I have questions about their policy.

I will respect the confidentiality of the group and will not record anything in the session, including but not limited to screenshots, video or audio recordings or dictation. I understand that everything that is said in group stays in group and I will respect the privacy of others, both on and offline.

I understand that the group facilitators reserve the right to remove anyone from the group with or without warning if they are not abiding by the guidelines set by the group or are acting in a way that compromises the purpose of the group.

I understand that this is a peer group that fosters social connection, not a clinical therapy group.

I understand that this is a space to build a circle of friendship and support. It is not the appropriate place to find hook ups, hit on or proposition others or talk about people in a sexualized manner.

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* 7. Parent's full first and last name (typing name is accepted as a signature).

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* 8. Today's Date

Please type today's date.

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