Men's Council 2026
Women Hold the Key
January 8 - March 26, 2026
AGES: 21 yrs and older
NEXT
TRANSLATE THIS FORM: Español, Português, Tiếng Việt, Tagalog, Kreyòl ayisyen
FOR WHOM?
I WILL PARTICIPATE
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)
BACK
NEXT
HOUSEHOLD/FAMILY DETAILS:
PARTICIPANT MAILING ADDRESS:
* ONLY IF OUTSIDE OF USA
BACK
NEXT
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
BACK
NEXT
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.
BACK
NEXT
CHECK BOX FOR THIS OPTION:
DONATION
COUNCIL, MC-DONATION
Free of charge thanks to Vashon Health District. We invite participants to make a donation for future scholarships.
$0.00
SHOPPING CART
ADJUST QUANTITIES:
ITEM
QUANTITY
SUBTOTAL
BACK
NEXT
ALMOST DONE, KEEP GOING!
PLEASE COMPLETE THIS VALIDATION:
BACK
×