Rainbow Coffee House 22/23
Please fill out this form and click submit.
Name
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Date of Birth
*
Pronouns
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Email
*
Phone
*
Address
*
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Are your parent(s)/legal guardian(s) aware of your queer identity?
*
Do you have any allergies or medical concerns we should be aware of?
*
I acknowledge that I am currently under the age of 18 years old.
*
Please select all that apply.
Yes, under 18 years of age
Emergency Contact
In the case of an emergency, RCH needs to have a safe person for us to contact. Please provide information about a safe adult in which we can contact if the need arises.
Name of Emergency Contact (Must be 18+)
*
Emergency Contact Phone Number
*
Is your emergency contact aware of your queer identity?
*
PLEASE NOTE! Rainbow Coffee House is expressly for Middle and High School age students. ALL participants MUST be under the age of 18 at the beginning of the school year.
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Description
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