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Home
About
News & Stories
Forms
Donate
Calendar
Youth Resources
Contact
Youth Connection Form
Youth Connection Form
Youth Connection Form
Youth's Name
*
First and Last Name
Date of Birth
*
Month, Date, Year
Age
*
Address
*
please include if you live in North Battleford, Battleford or a surrounding community.
Contact Information - Phone Number/Email
*
Gender Identity
*
Male
Female
Transgender
Transgender
Non-binary/non-conforming
Prefer not to respond
Ethnicity
*
Indigenous
Metis
Asian
Black/African
Hispanic/Latinx
Caucasian
Other
Prefer not to respond
School
*
Elementary
Sakewew High School
John Paul II Collegiate
John Paul II Collegiate
North Battleford Comprehensive High School
Other
Other
Grade
*
Allergies / Medications
*
Guardian Name, Relationship and Contact Information (Phone Number/Email)
*
Referred By
*
Phone
*
Email
*
Obstacles Youth are Facing
*
More Details (if needed)
Involvement with Community Organizations (ex: Boys & Girls Club, Big Brothers Big Sisters of the Battlefords, Community Corrections, Counsellor...)
*
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