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Girls Inc. of Alameda County: 2024-25 Health & Advocacy Application

Get to Know You

Welcome! We’re excited to learn more about you. Please fill out the following information to help us get to know you better. If you have any questions, feel free to ask!

1. First and Last Name: *This question is required.

Age:

*This question is required. This question requires a valid number format.

4. Youth (your) Contact Information: *This question is required.

Name
Address
City
ZIP Code
Phone Number
Email address (if any)

5. Parent/Guardian Contact Information: *This question is required.

Name
Address
City
ZIP Code
Phone Number
Email address (if any)

6. Participant's Race (Check all that apply, if "Other" please specify): *This question is required.