AWCS Youth Secret Movie Night

Youth Name * Maximum of 50 characters

Youth Age and Grade * Maximum of 50 characters

Youth Email and Phone Number (optional) Maximum of 50 characters

Tell us how we can make this the best program for you (pronouns, preferred name, neuro-diversity, disability, goals, etc.) Maximum of 1000 characters

Are you bringing a guest(s)? Select all that apply Yes No

Please give us the name of your guest(s). (if no guest, use N/A) Maximum of 200 characters

The AWCS Youth Program requires ALL youth to have all their childhood vaccines AND at last two doses of the COVID-19 vaccine or a doctor's letter of exemption (proof may be required). Select all that apply Yes! My Child has their vaccines. I will bring a doctor's letter of exemption.

Media Release - at times we may create or post pictures, video, audio, of our programs which we will post to our social media and websites without names (unless specifically requested). Do you understand and agree to this? Select all that apply Yes No

Guardian Name(s) (Full) * Maximum of 50 characters

Guardian Email Address and Phone Number * Maximum of 100 characters

Secret Movie Night

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