Bright Futures Registration Form- Old Worthington Library

Thank you for participating in YWCA Columbus's 2024 Bright Futures program with Old Worthington Library.

We are so excited for you to learn, grow, and have fun with us this fall!

For many years, Bright Futures has empowered girls and gender-nonconforming youth by shedding light on the social justice issues that impact them and encouraging them to take action.

The program consists of a six-part series of Empowerment Workshops focused on social justice and leadership. Through engaging discussions and activities centered around issues like racism, sexism and intersectionality, we seek to up-end insecurities rooted in oppressive ideas and institutions, and equip participants with the tools and knowledge to advocate for social change. Our program is going to be held on each Wednesday from October 9th-November 13th in the OWL meeting room at the Old Worthington Library, located at 820 High St. Worthington, Ohio 43085.

For any questions, please reach out to the Program Coordinator, Navya Nalla at nnalla@ywcacolumbus.org

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* 1. First and Last Name

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* 2. What is the t-shirt size of the youth participating in the prorgam?

Adult Small

Adult Medium

Adult Large

Adult X large

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* 3. Gender Pronouns

she/her

he/him

they/them

other

Prefer not to say

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* 4. School Name

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* 5. Grade

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* 6. Date of Birth

Select below

Date

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* 7. Age

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* 8. Participant's Phone Number

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* 9. Participant's Email Address

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* 10. Race/Ethnicity

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* 11. Home Address

Address

City

State

Zipcode

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* 12. Parent/ Guardian Information

Full Name

Relation to Participant

Phone Number

Email Address

Address

City, State , Zip Code

Bright Futures Registration Form- Old Worthington Library

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* 1. First and Last Name

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* 2. What is the t-shirt size of the youth participating in the prorgam?

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* 3. Gender Pronouns

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* 4. School Name

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* 5. Grade

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* 6. Date of Birth

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* 7. Age

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* 8. Participant's Phone Number

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* 9. Participant's Email Address

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* 10. Race/Ethnicity

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* 11. Home Address

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* 12. Parent/ Guardian Information

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* 13. Family Size

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* 14. Household Income

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* 15. Are there any allergies that your child has that we should know about?