Name: Summer Focus Group Session 3
Start: 2025-08-12T12:00:00-04:00
End: 2025-08-12T12:00:00-04:00
Location: Tri-Town Youth Services

Participant First Name*

Participant Last Name*

Participant DOB

Please list any allergies participant has*

Which School does Participant attend?

Email*

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email*

Phone

Name of individual picking up participant*

Emergency Contact Phone Number*

Emergency Contact Name*

I grant Tri-Town Youth Services permission to use my/my child’s image in photos or videos for promotional, educational, and outreach purposes, including print, digital, and social media. I understand no compensation will be provided, and I release Tri-Town Youth Services from any liability related to image use.*

Yes

No

By checking the box, I give permission for my child to participate in a Tri-Town Youth Services focus group. I understand that my child will receive a $20 incentive and lunch. Participation is voluntary and responses are confidential.*

Summer Focus Group Session 3

August 12 @ 12:00 PM

Details

Organizer

Venue

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