Community Care & Safety Day

3rd Space Registration

First Name *

Last Name *

Email *

Phone

Do you identify as Lesbian, Gay, Bisexual, Two-Spirit, Trans, and/or Gender Non-Conforming? *

Yes No

Are you Black, Indigenous, or a Person of Color? *

Yes No

For the health & safety of our community, we require COVID-19 testing & masking at all of our in-person and hybrid events. Please confirm that you are willing to respect these protocols. (Masks & tests will be provided) *

Yes No

Do you have any access needs and/or dietary restrictions?

Photo Release Form

Yes No

Do you need interpretation for this event?

Yes No

If you need interpretation, what is your primary language?

Other

Community Care & Safety Day

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