Youth who want to join a pod

Personal Information

Date of Birth

Parent / Guardian Information

Community & Matching Information

Youth Interests & Strengths

Health & Safety Information

Note: Pod Leaders are NOT medical professionals; this is for awareness only.

Youth Code of Respect

A simple agreement to ensure a safe and uplifting environment.

Youth must check:

Schedules & Commitment

Can you commit to attending 2 sessions per month?
Preferred Days/Times (select multiple)
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