Youth Participant

WELCOME TO THE 3rd LGBTQ+ Youth Holiday Drive in the San Fernando Valley:

We know how tough the holiday season can be for LGBTQ people, particularly for LGBTQ youth in the San Fernando Valley. This 3rd annual LGBTQ youth holiday drive will focus on youth participants up to the age of 18. Whether you are out and proud, or still working on yourself, please apply to receive a gift. We are here for you and you are worthy of support, honor, and a powerful sense of belonging. Fill out the form to become a youth participant. DEADLINE to submit your request: SUNDAY DECEMBER 9, 2018. Our event will take place on Wednesday DECEMBER 19 at Pacoima City Hall (see flyer above for details). Sign up early! ;)

*Please keep in mind that our community supporters (the people committed to provide gifts for this year's holiday drive) will do everything in their ability to match your gift requests or offer the closest thing possible to it.

YOUTH (AGES 10-18) PARTICIPANT REGISTRATION

* Indicates required field

Name *

First

Last

Pronouns (he/she/they...) *

How do you identify? (trans, queer, agender, genderfluid, bi, pansexual, lesbian, gay...) *

Email *

Phone Number *

Languages you speak *

Zip Code *

If extended family, teacher, counselor, or friend is filling out this application in support of a child/teen, please provide your name (adult ally) and relationship to the youth member *

Age range *

10-14 15-18 Just turned 18!

WISHLIST: Be as specific as possible (i.e. pokemon toy or "Redefining Realness" by Janet Mock, or gift card to TARGET). Mention three gift options you want. List them in preferred order with 1 being the favorite item. Make sure to include at least one gift card idea. We will add it to the current wishlist available for SPONSORS. If community supporters cannot exactly match your gift request(s), they will try to offer something similar. *

Please share a short bio about yourself *

What would you like your community supporter to know about your hopes for the future? *

Wish to receive the gift *

In person at the event @ Pacoima City Hall on Wed, Dec 19 At a different time and place

Any last comments or requests to make you feel safer about your participation? *

Submit

BE A SPONSOR: I COMMIT TO PROVIDE A GIFT

WELCOME TO THE 3rd LGBTQ+ Youth Holiday Drive in the San Fernando Valley:

YOUTH (AGES 10-18) PARTICIPANT REGISTRATION

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