COLAGE: BAY AREA

ACT Up ACT Out

Activism Through Theater

Workshop series for Teens with one or more LGB and/or T Parent

Registration Form

Personal Information

First Name:

Middle Name:

Last Name:

Birth Date:

Address Information

Street Address:

City/Town:

State:

Zip Code:

Phone Number:

Other Phone:

E-mail:

Family Information

Parent(s) Name(s):

Family Background (lesbian mom(s), gay dad(s), bisexual parent(s), transgender parent(s), straight parent(s), etc.):

General Information

School Attending:

School Address:

To receive the stipend participants are expected to attend all sessions.

Please note below if you have any conflicts:

Thursday, April 20th from 5:30 to 9pm:

Saturday, April 22nd from 2 to 5:30pm:

Sunday, April 23rd from 2 to 5:30pm:

Thursday, April 27th from 5:30 to 9pm:

Saturday, April 29th from 2 to 5:30pm: