Bay Area Teen Trans Day of Visibility Celebration

Tell us who you are!

I am a teen.

Will you be joining us for the celebration?

Yes

The event will take place at a location in the Mission Dolores neighborhood in San Francisco. Exact location will be emailed to all registrants.

Keshet presets in partnership with BBYO and the JCCSF teen leaders day-long workshop for all LGBTQ and ally teens to celebrate and provide visibility for trans and non-binary teens. This program is FREE and is open to all LGBTQ teens and allies who want to connect through learning, art, performance, and community!

This event is made possible by The Jewish Teen Education and Engagement Initiative (Teen Initiative). The Teen Initiative is a project of the Federation, in partnership with Jewish Federation and The Jewish Community Foundation of the East Bay, and with support from the Jim Joseph Foundation.

Comments (optional):

Your Contact Information

Title

First Name

We respect your privacy and will not share your personal information.

Last Name

Preferred Name (if different from above)

Legal/Given First Name (if different from above)

We require this name on record for emergency purposes.
We will not use this publicly.

Which name would you like Keshet to use when communicating with you and your family by email and phone?

First Name (Chosen Name)Legal/Given Name

E-mail

E-mail Type

Phone Number

Phone Number Type

Zip / Postal Code

I've recently moved and would like to update my address!

Please use discretion when contacting me.

Address

Type:

Organization Name

Street

City / Town

State/Province/Region

Zip / Postal Code

Country

Is your billing address the same as your mailing address?

Yes

This field is optional, but encouraged!We use email addresses to communicate about day-of logistics and to share Keshet upcoming events and resources!

Additional Registration Information

Why do we ask these questions?
We use the answers to these questions so that we can better serve YOU. We use this information to make sure that you hear about events and programs exclusively for people your age!

Your Birthday

Month

Day

Year

Anticipated high school graduation year:

With which of the following groups are you affiliated? Check all that apply.

Keshet	CBST
JCC Manhattan	JQY
Ansche Chesed	Beth El Synagogue Center
Eshel	Footsteps
METNY USY	Sephardic-Mizrahi Q Network
None of the above

What are your pronouns? (optional)

Which of the following pronouns do you use (even if the same as above)? (optional)

She/Her/Hers	He/Him/His	Ze/Hir/Hirs
They/Them/Theirs	No Pronoun	No Preference
Not Listed

Do you have any dietary restrictions we should be aware of? (All food at the event will be Kosher.)

Vegan	Nut Allergy	Vegetarian
Dairy Allergy	Gluten-Free	Other (describe below)
None

Other dietary restrictions

Do you require any transportation assistance?

Yes

Please describe the transportation assistance required:

There will be an uber code sent to you

Anything else we should know?

Would you like to register any of your family members?

Yes!

Family Member Information

Full Name:	Age (if 18 or under):
Email: This field is optional, but encouraged! We use email addresses to communicate about day-of logistics and to share Keshet resources and upcoming events! Relationship to you:

Which event(s) will your family member be attending?

Pride Brunch

Pride March

Emergency Contact Information

Full Name

Phone Number

Relationship to You

Photo Release Agreement

Will you give Keshet and its program partners* permission to use pictures or videos of you taken at this event?*

The Photo Release only applies to you and not to any others you are registering through this form.
*Keshet's program partners include: Jewish Community Center of the East Bay

Yes!No thanks.

Are you 18 or older?

YesNo

You AND your parent/guardian will need to electronically sign our Photo Release Agreement.

Please note that your parent/guardian will receive an email with your registration confirmation and your photo permissions agreement. Your preferred name will not be included in this email.

Keshet Photo Release Agreement
As an organization working with the LGBTQ and ally community, Keshet takes its responsibility to maintain privacy very seriously. As such, we require written consent from participants, or their legal guardians if participant is a minor, before using photos or videos of participants.

Location: San Francisco, CA
Date: Sunday, March 31st, 2019

I authorize KESHET and the aforementioned program partners to use, in whole or in part, my name, likeness, image, voice, biography, interview and performance in connection with the Keshet Teen Trans Day Of Visibility Celebration, in all manner and media, as KESHET and the aforementioned program partners shall determine in its sole discretion. KESHET and the aforementioned program partners, and their successors and assigns, shall own all right, title and interest, including the copyright(s), in and to the Keshet Teen Trans Day Of Visibility Celebration, to be used and disposed of throughout the world in perpetuity without limitation as KESHET and the aforementioned program partners shall determine in their sole discretion.

I am the teen named above, and I hereby consent to the preceding agreement on behalf of myself.

Yes, I give my consent.No, I do not give my consent.

Participant Signature

Please write your full name, which will serve as your electronic signature.

I am the parent or guardian of the minor named above, and I hereby consent to the preceding agreement on behalf of the minor and myself.

Yes, I give my consent.No, I do not give my consent.

Parent/Guardian Signature

Please write your full name, which will serve as your electronic signature.

Relationship to Participant

Parent/Guardian Email

We will send a confirmation email to your parent/guardian with this agreement.

I am the adult named above, and I hereby consent to the preceding agreement on behalf of myself.

Yes, I give my consent.No, I do not give my consent.

Participant Signature

Please write your full name, which will serve as your electronic signature.

Questions? Please contact Randi Reed [email protected] or Amram Altzman [email protected].

Admin Fields

MergedEmail

GroupCalc

Authorize Address Line 1

Authorize Address Line 2

Authorize State/Province/Region

Authorize Zip / Postal Code

Authorize Country

Address Filled Out

Authorize Org

Total Cost

AUTHORIZE_DOT_NET_CREDIT_CARD_SUFFIX

AUTHORIZE_DOT_NET_STATUS

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About You

Have you ever been to a Keshet event?

YesNo

Welcome back!

Welcome! We're so glad you're joining us!

Would you like to share or update any of your identity information? (All questions are optional.)

Yes, please!No thanks.

The following questions are optional.
We appreciate your answers to any and all questions you feel comfortable completing. Your responses help Keshet staff better serve YOU! All answers will be kept confidential.

Self-identification is important, and we understand that we each have our own understanding of the words used to describe our own experiences. So that we can best honor your identity and experiences, please describe how you identify in the free response box AND select (as many as you want) from the list below.

In your own words, what is your gender identity?

Select the term(s) with which you most identify, even if the same as above.

AgenderCisgender (non-trans) ManCisgender (non-trans) WomanGender Non-conformingGender VariantGenderqueerIntersexNon-binaryQueerTransgender ManTransgender WomanNot Listed

In your own words, what is your sexual orientation?

Select the term(s) with which you most identify, even if the same as above.

AsexualBisexualGayLesbianPansexualQueerStraightNot Listed

Are you affiliated with a youth group?

Yes

ex: BBYO

Which organization?

Region/Chapter

Are you affiliated with any of the following movements, teen groups, or camps? (Check all that apply)

Camp JRFCamp RamahJCC campJCC teen groupJQI (Los Angeles)JQYMosaic of WestchesterMoving Traditions/Rosh Hodesh: It’s a Girl Thing!/Shevet Achim: The BrotherhoodYoung JudaeaNone of the above

Do you have any accessibility needs we should be aware of?

Do you have any dietary restrictions we should be aware of? (All food will be Kosher.)

VeganVegetarianGluten-FreeNut AllergyDairy AllergyOther (describe below)None

Other dietary restrictions

We rarely charge for events. Would you like to make a donation to Keshet to help cover the costs of our programming?

$5$10$20OtherSorry, not right now.

Enter other amount

.00 USD

Credit Card Information