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Parent/Guardian Name
*
First
Last
Who will be leading the child or group through the service activity?
Email
*
Email
Confirm Email
All volunteering information and activities will be sent to this address.
Parent/Guardian Phone
*
Address
Address Line 1
Address Line 2
City
— Select state —
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Youth Participant #1
If completing this project as a group larger than 6 please skip individual youth registration and check the group box and select the age range.
Youth Participant #1 Birthday
MM/DD/YYYY
Youth Participant #2
If completing this project as a group larger than 6 please skip individual youth registration and check the group box and select the age range.
Youth Participant #2 Birthday
MM/DD/YYYY
Youth Participant #3
If completing this project as a group larger than 6 please skip individual youth registration and check the group box and select the age range.
Youth Participant #3 Birthday
MM/DD/YYYY
please Action Agreement
Youth Participant #4
If completing this project as a group larger than 6 please skip individual youth registration and check the group box and select the age range.
Youth Participant #4 Birthday
MM/DD/YYYY
Youth Participant #5
If completing this project as a group larger than 6 please skip individual youth registration and check the group box and select the age range.
Youth Participant #5 Birthday
MM/DD/YYYY
Youth Participant #6
If completing this project as a group larger than 6 please skip individual youth registration and check the group box and select the age range.
Youth Participant #6 Birthday
MM/DD/YYYY
This project will be completed by a group larger than 6. Please select the range of YOUTH ages 2-14 volunteers in your group.
7-10
11-15
16-20
21-25
Greater than 25
Please do NOT include adults or youth older than 15 in your count.
Group Affiliation
Youth group, scouts, elementary school classroom, etc. You only need to complete this field for groups larger than 6 when applicable.
How did you hear about Youth Action Collective?
*
Friend/Family
Social Media
Child Care/School
Other
If you selected 'other' please share below:
Youth Action Collective Service Agreement
*
I agree to the following terms:
-Use the lesson materials solely for the purpose of completing the designated volunteer project.
-Engage with the materials in good faith, applying the knowledge and skills learned to contribute effectively.
-Refrain from altering, misusing, or distributing the materials for purposes unrelated to the volunteer project.
-Respect any confidentiality or guidelines associated with the materials.
Youth Action Collective Media Release
*
I agree to the following media terms:
I do NOT agree to these terms:
Media Permission Release
By submitting this form, I give permission for Youth Action Collective to photograph, video record, and/or share images, video, and audio of all individuals listed on this form. I understand that these may be used for promotional, educational, or informational purposes in print, online, and social media platforms.
I confirm that I have the authority to grant this permission for all individuals listed.
Submit