Quick Registration (NEW Gold Star Gamers)

Guardian Information

Last Name *This question is required.

First Name *This question is required.

Email Address *This question is required. This question requires a valid email address.

Primary Cell Phone Number (555-555-5555) *This question is required.

Gender

By checking this box you acknowledge and consent to receive text messages to the phone number provided. *This question is required.

Secondary Phone Number

Discord Username (if you have one):

Street Address *This question is required.

Apt/Suite

City *This question is required.

Other State or Territory *This question is required.

Zip *This question is required.

Do you enjoy gaming?

If you said other, please specify. *This question is required.

If you said Other to your Relationship to Deceased Servicemember: *This question is required.

Military & Affiliation Information of the Guardian

*This question is required.

Did you serve in the military? *This question is required.

Is the child the adopted or biological child of a deceased US servicemember or veteran? *This question is required.

Is the child the adopted or biological child of a deceased first responder or federal government employee?

If neither of the above apply but you still want to be considered for the program, pelase explain here:

Deceased Servicemember Information

Servicemember name: *This question is required.

Rank: *This question is required.

Branch of Service *This question is required.

Date deceased: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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How was gaming meaningful to the military parent? Has your family ever used gaming to connect with the service

member? Please share any stories.

*This question is required.

Servicemember Photo (upload)

File: {{filename}} delete

If available, photo of servicemember and child (upload)

File: {{filename}} delete

Child Information (one form per child)

Last Name *This question is required.

First Name *This question is required.

Preferred Name *This question is required.

Date of Birth *This question is required. MM/DD/YYYY This question requires a valid date format of MM/DD/YYYY.

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Email Address This question requires a valid email address.

Phone Number (555-555-5555)

Gender *This question is required.

If you said other, please specify. *This question is required.

Favorite Color

Favorite professional sports team(s);

Do you want to enroll your child in the GSG peer support discord? *This question is required.

Would you like your child to join our GSG Mentorship Program?