Outreach Youth Registration Form

Youth Information

Name of Youth

Youth Email

Youth Phone

School

Grade

Parent/Guardian Information

Parent/Guardian Name

Parent/Guardian Email Address

Relationship to Youth

Parent/Guardian Phone Number

Select the social media platform you are currently using

Kindly prioritize your areas of interest by assigning a ranking from 1 (highest interest) to 4 (lowest interest). This will help us understand your preferences better

	1	2	3	4
Marketing	1Marketing 1	2Marketing 2	3Marketing 3	4Marketing 4
Social Media	1Social Media 1	2Social Media 2	3Social Media 3	4Social Media 4
Graphic Design	1Graphic Design 1	2Graphic Design 2	3Graphic Design 3	4Graphic Design 4
Communication	1Communication 1	2Communication 2	3Communication 3	4Communication 4

If the interest listed above didn't pique your interest, we'd love to learn more about your unique skills and passions! Please share with us what topics, hobbies, or expertise you're enthusiastic about, so that we can tailor our future content to better align with your interests and engage you accordingly.

Consent & Agreement

Checkboxes

I hereby allow my child to participate in the chosen program and agree to the terms and conditions laid out by the RKMCC

Date

Custom Captcha

9 * 12 =

Youth Information

Parent/Guardian Information

Consent & Agreement

Join Us

Get in Touch

Address

Hours

Join Us

Get in Touch

Hours

Address