Initiators 2026
One Village
January 14 - May 6, 2026
AGES: 15 - 19
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TRANSLATE THIS FORM: Español, Português, Tiếng Việt, Tagalog, Kreyòl ayisyen
FOR WHOM?
I WILL PARTICIPATE
I AM A PARENT OR GUARDIAN
REGISTERING A NEW CHILD/MINOR TO PARTICIPATE
I AM A RETURNING PARENT OR GUARDIAN:
OUR FAMILY or HOUSEHOLD HAS REGISTERED FOR OTHER PROGRAM ACTIVITIES WITHIN THE PAST 3 YEARS
YOUR (PARENT/GUARDIAN) NAME:
YOUR (PARENT/GUARDIAN) CONTACT INFORMATION:
NAME:
NICKNAME: (optional)
(not parent)
CONTACT INFORMATION:
(OPTIONAL)
BIRTHDATE:
Please enter a valid birthdate here...
GENDER:
Please enter a gender information here...
use button or write in anything!
Male
Female
Non-Binary
PRONOUNS:
use button or write in anything!
He/Him/His
She/Her/Hers
They/Them/Theirs
LANGUAGE:
(only if not English)
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HOUSEHOLD/FAMILY DETAILS:
PARTICIPANT MAILING ADDRESS:
* ONLY IF OUTSIDE OF USA
YOU MAY ENTER ONE OR TWO RELATED ADULTS
WHO LIVE or WORK AT THIS ADDRESS:
ADULT #1
(optional)
parent, step-parent, guardian, spouse, etc.
(optional)
ADULT #2
(optional)
parent, step-parent,
guardian, spouse, etc.
(optional)
I WANT TO INCLUDE ANOTHER ADULT/PARENT/GUARDIAN AT A DIFFERENT ADDRESS
OTHER ADULT
(optional)
parent, step-parent, guardian, spouse, etc.
(optional)
OTHER MAILING ADDRESS:
* ONLY IF OUTSIDE OF USA
SUBMIT ADULT CONTACT INFORMATION
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HOW DID YOU FIND US?
Please help us understand
which of our marketing efforts are most effective
by checking the factor or factors
that most influenced your decision to register!
WORD-OF-MOUTH:
heard about it from a friend or family member
WEB:
searched for something on the internet and found your website
SOCIAL-MEDIA:
saw something on social media: Instagram, Facebook, etc.
GROUP:
participated as part of our school or other group program
EMAIL:
received a marketing email or e-newsletter from you
BROCHURE:
received or read a printed brochure or program catalog
POSTER:
saw a poster on a bulletin board
PRINT:
saw a printed advertisement or article in a newspaper or magazine
ADVISOR:
A school counselor, advisor, or paid consultant recommended it
ENCOUNTER:
randomly encountered your staff or students while we were out in the world
EVENT:
found your table or display at a school, fair, or other public event
MYSTERY:
A mysterious force has led me here; I cannot explain it
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IMPORTANT DETAILS:
DIET:
NONE
Please describe any special dietary restrictions, and indicate whether they result from personal preference, religious custom, or medical necessity.
ALLERGIES:
NONE
Any ALLERGIES?
To foods? To medications? To insect stings or other environmental agents?
If so, please explain the symptoms and the severity of these allergies: ( MILD DISCOMFORT or SEVERE LIFE THREATENING ANAPHYLAXIS )
MEDICATIONS:
NONE
Any regular MEDICATIONS? If so, please list the medications, their dosage and frequency, and their purpose. This information may be used to administer medications during a program, but more importantly it will help medical professionals in the event of an emergency.
CONCERNS:
NONE
Tell us any concerns you may have about participation in our programs: Any
injuries or physical limitations
, or any
emotional, behavioral, or mental health issues
, any
sleep issues
,
substance abuse
, history of
infections
, or anything else that you can let us know in advance to help our staff to make the program safe and enjoyable for everyone.
Please note: failure to disclose significant medical or learning issues undermines our work and the safety of our programs, and we reserve the right to dismiss any participant who arrives with undisclosed conditions.
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INITIATOR INTERVIEW QUESTIONS
Please provide answers to the following questions.
What does leadership mean to you? ¿Qué significa el liderazgo para ti?
What are 1-2 leadership goals you have for yourself in the near future? ¿Cuáles son 1-2 metas de liderazgo que tienes para ti mismo/a en un futuro cercano?
How are you currently engaged in your community? List a few of your primary activities and commitments. ¿Cómo participa usted actualmente en su comunidad? Enumere algunas de sus principales actividades y compromisos.
SUBMIT THIS SECTION
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ALMOST DONE, KEEP GOING!
PLEASE COMPLETE THIS VALIDATION:
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