Youth Advisory Meeting Registration

When: October 4th, 2019
Where: 161 S. Main Street
Time: 4:30pm - 5:30pm

Cost: FREE
Pizza and refreshments will be provided.

Legal Name *
Legal Name
F.R. Pride is a safe and inclusive space and the information in you provide is confidential and protected under Massachusetts General Laws Ch. 111. Sec 70. Your written consent will be required for release of information except in the case of a court order.
While F.R. Pride recognizes a number of genders and sexes, many insurance companies and legal entities unfortunately do not. Please be aware that your legal name and gender on your state identification must be used on documents pertaining to insurance, billing and correspondence. If your preferred name and pronouns are different from these, please let us know.
Phone *
Phone
Please let us know the best way to reach you!
Address
Address
Grade Level *
Availability *
Please select one or more options
Space is limited. Participants are allowed to bring one additional guest.
Guest Information (If applicable)
For the safety and security of all of our staff and guests we require general information on all visitors of F.R. Pride.
Guest Legal Name
Guest Legal Name
Guest Preferred Name
Guest Preferred Name
Phone
Phone
Parent Guardian Information
If you are under the age of 19, the Department of Public Health requires that you provide parent/legal guardian contact information.
Parent or Legal Guardian Information
Parent or Legal Guardian Information
Phone
Phone
This is NOT required to participate however, your feedback is appreciated. Please let us know why you want to join the Youth Advisory Council.