ShoutOUT Registration Form

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ShoutOUT Signup Form

Name of Parent/Guardian

Email

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Name of Youth

Pronouns

Youth Date of Birth

Current Grade in School

Any allergies?

Anything else we should know working with your child?

Thank you for helping us make a difference!

Bringing the community together through LGBT+ education, advocacy, and activities in the Centre County region.

We have so many exciting things going on, be the first to find out!

Enter Your Email here

Thanks for submitting!

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