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Dia Festivo Registration Survey

Dia Festivo Registration / Registración para el evento Día Festivo

Please, fill in the information on this Registration to participate in the Dia Festivo event: December 17th, 2022
This event is free for the community: Rogue Valley Mentoring will use this information to provide support to your family this holiday season, and meet our data requirements as a non-profit.  Each student will receive a Christmas basket.

Por favor, complete la información en esta Registración para participar en el evento: 17 de diciembre de 2022
Este evento es gratuito para la comunidad: Rogue Valley Mentoring utilizará esta información para brindar apoyo a su familia en esta temporada navideña y cumplir con nuestros requisitos de datos como organización sin fines de lucro. Cada estudiante recibirá una canasta de regalo navideño.

 
1. Would you prefer to complete this form in English or Spanish?
¿Preferiría completar este formulario en inglés o en español?
  *This question is required.
Was your family affected by fires in Southern Oregon? 
This will not affect your eligibility to participate in the event. *This question is required.
¿Su familia fue afectada por los incendios del Sur de Oregon? 
Esto no afectará su elegibilidad para participar en el evento. *This question is required.
Youth Information: provide the following information for each youth in your family.
**If you have more than 5 youth in your family, please contact EMartinez@rvmentoring.org
Información del estudiante: proporcione la siguiente información para cada joven de su familia.
**Si tiene más de 5 jóvenes en su familia, comuníquese con EMartinez@rvmentoring.org
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid date format of MM/DD/YYYY.
calendar
Youth 1 Gender: *This question is required.
Género: *This question is required.
Youth 1 Race: please, check all that apply *This question is required.
Raza: por favor seleccione todos los que aplican *This question is required.
What are Youth 1's Interests?
  • * This question is required.
¿Cuales son los intereses de su estudiante?
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid date format of MM/DD/YYYY.
calendar
Youth 2 Gender: *This question is required.
Género: *This question is required.
Youth 2 Race: please, check all that apply *This question is required.
Raza: por favor seleccione todos los que aplican *This question is required.
What are Youth 2's Interests?
  • * This question is required.
¿Cuales son los intereses de su estudiante?
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid date format of MM/DD/YYYY.
calendar
Youth 3 Gender: *This question is required.
Género: *This question is required.
Youth 3 Race: please, check all that apply *This question is required.
Raza: por favor seleccione todos los que aplican *This question is required.
What are Youth 3's Interests?
  • * This question is required.
¿Cuales son los intereses de su estudiante?
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid date format of MM/DD/YYYY.
calendar
Youth 4 Gender: *This question is required.
Género: *This question is required.
Youth 4 Race: please, check all that apply *This question is required.
Raza: por favor seleccione todos los que aplican *This question is required.
What are Youth 4's Interests?
  • * This question is required.
¿Cuales son los intereses de su estudiante?
This question requires a valid date format of MM/DD/YYYY.
calendar
This question requires a valid date format of MM/DD/YYYY.
calendar
Youth 5 Gender: *This question is required.
Género: *This question is required.
Youth 5 Race: please, check all that apply *This question is required.
Raza: por favor seleccione todos los que aplican *This question is required.
What are Youth 5's Interests?
  • * This question is required.
¿Cuales son los intereses de su estudiante?
Parent/Guardian: please, sign here to confirm all information on this application is true and correct to the best of your knowledge. *This question is required.
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Padre/Madre o Tutor: por favor, firme aquí para confirmar que toda la información en esta solicitud es verdadera y correcta a su saber y entender. *This question is required.
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Signature of