Teens for Destiny Registration Form

Greater Destiny Church (GDC), MultiCultural Child & Family Hope Center (MCFHC) and Answers Counseling are hosting monthly Teens for Destiny sessions! If you are a teenager 12 - 19 years old and living in Pierce County, we invite you to participate on 3rd Thursday of Each Month from 4pm-5:30pm. We will be discussing Life Skills, Social/ Emotional Wellness, Preventative Health, and Equity & Social Justice Leadership. You will receive a $20 online Amazon gift card each month that you participate in the Zoom session and complete a quiz/ survey. Either parents/ primary caregivers or teens can fill out this registration form. We will be verifying the Teen's identity and information. Thank you.

Greater Destiny Church thanks the Washington State Department of Health for this funding. The project described is being supported by Grant Number TP2AH000062 from the HHS Office of Population Affairs. Contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services or the Office of Population Affairs.”

- Pastor Ivan Johnson and Joi Taylor (greaterdestinychurch@outlook.com)
- Roxy Magno, and Turner Cagle (rmagno@mcfhc.org)
- Suzanne Pak and Rob Ziemak (suzanne@answerscounseling.org)

1. Teenager's First Name *This question is required.

2. Teenager's Last Name *This question is required.

3. Teen's Email Address *This question is required.

4. Teen's Cell Phone Number *This question is required.

5. Teen's Age *This question is required.

Please enter an 'other' value for this selection.
Please enter an 'other' value for this selection.

6. Teen's Home Address (Street address, City, and Zip code) *This question is required.

7. Name of the School the Teen is Attending *This question is required.

8. Teenager's Race/ Ethnicity (can select more than one): *This question is required.

9. Teenager's Gender *This question is required.

Please enter an 'other' value for this selection.

10. Who Did You Hear About Teens for Destiny from? (Full Name and Organization) *This question is required.

11. Parent/ Primary Caregiver's First & Last Name *This question is required.

12. Parent's Email Address *This question is required.

13. Parent's Cell Phone Number *This question is required.

14. Please Check One of the Boxes Indicating Your Consent with the Gift Card Process: *This question is required.