Youth Program Registration and Demographics Form

Greetings Girls on the Mic (GOTM) students!

We are thrilled that you are joining our program. GOTM is a FREE creative technology and digital media production training, serving San Francisco Bay Area girls and gender-expansive youth ages 11-18, focusing on topics such as Beatmaking, Songwriting, Sound Design, Coding Music, and much more.

Please take a moment to fill out the following forms so that we can continue to offer this program free of charge to youth in San Francisco. Your responses will remain confidential, and demographic questions are optional.

Let us know if you have any questions! We are always happy to hear from you.

Vivienne Alcantar, Girls on the Mic Program Manager
Women’s Audio Mission
valcantar@womensaudiomission.org

(800) 926-1338 x703

"*" indicates required fields

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Form Settings

Instructions: Use these fields to configure the form for each season. Update Program Name, Season, etc. Parameters are passed into the form using the https://url.org?param1={value1} & param2={value2} structure.

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Program Name

This is a 'Settings' field that should be updated for each Season of the GOTM program. It is used when submitting the data to Salesforce.

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Program ID

This is a 'Settings' field that should be updated for each Season of the GOTM program. This is the Salesforce ID of the Program Named above. It is used when submitting the data to Salesforce.

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Season

This is a 'Settings' field that should be updated for each Season of the GOTM program. It is used when submitting the data to Salesforce.

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Year

This is a 'Settings' field that should be updated for each Season of the GOTM program. It is used when submitting the data to Salesforce.

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Role

This is a 'Settings' field specifying the 'Role' on the Program Enrollment. It is used when submitting the data to Salesforce.

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Program Stage

This is a 'Settings' field specifying the 'Stage' on the Program Enrollment. It is used when submitting the data to Salesforce.

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Application Date

This is a 'Settings' field specifying the 'Application Date' on the Program Enrollment. It is used when submitting the data to Salesforce.

MM slash DD slash YYYY

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Entry ID

This field is used to pull information back into the form when the parent returns to fill out the Media Release information. It is passed into the form via the url using the {entry} parameter.

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Media

This field is used to determine if it's the parent returning the form to fill out the Media Release information. It is passed into the form via the url using the {media} parameter.

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Contact ID

This field is used when/if the Salesforce Contact ID is passed into the form using the {pid} parameter. If present we can submit to Salesforce knowing the specific Contact.

STUDENT REGISTRATION FORM

Student Name*

Please enter your legal first and last name. Information you share through this form will remain confidential.

First Last

Preferred Name

Do you go by a name other than your legal name?

Student Email

Student Birthdate*

MM slash DD slash YYYY

Class Location*

Where are you attending GOTM? (E.g. Oasis for Girls, Aim High, YMCA, etc.)

Other Location Not Listed:

What school do you attend?*

Where you go to school. Might be a different answer from class location!

What city do you live in?*

Other City*

Demographics (optional)

This section of the registration form is optional, meaning you can skip this part if you'd like by scrolling down to the bottom and pressing "submit." However, do know that your responses are confidential, and are only collected to understand the populations served by our programs.

Housing Status

Select one.

Home Language

Please select one primary language spoken in your home.

Race/Ethnicity

If more than one of the following apply to you, please select "multiracial/multiethnic." Otherwise, please select one.

Gender

What is your gender?

Female

Male

Genderqueer and/or Gender Non-Binary

Transgender

Declined to state

Do you identify as gay, lesbian, queer, or bisexual?

Select one response.

Yes

Declined to state

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MEDIA RELEASE

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Your Student First Name

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Parent/Guardian First Name

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Parent/Guardian Last Name

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Parent/Guardian Email

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WAM and DCYF Photography and Project Release

You or your child participates in a youth program with Women’s Audio Mission (WAM), which is funded by the San Francisco Department of Children, Youth, and Their Families (DCYF). WAM staff, DCYF staff, or contractors may on occasion visit this program to take photographs or video for public information projects. The public information projects aim to educate civic leaders and the general public about programs and services available for San Francisco children, youth and families. Example projects include DCYF publications and exhibits, as well as the DCYF website (http://www.dcyf.org). Women’s Audio Mission may use such photographs and/or video for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content (www.womensaudiomission.org). By signing this form, you authorize WAM staff to share your child’s work from this project as part of end-of-session sharing at the program site and promotion media and public information projects described above. If the student is under the age of 18, please have a parent or guardian read the information below. To sign, please check the box below.

I have read and agree to the terms listed that authorize WAM staff and DCYF contractors to take photographs of program activities that may include images of you or your child and use these photographs for the media and public information projects.

I do not consent to the above release form

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Media Release Date

MM slash DD slash YYYY