Program Registration Form - Alianza Coachella Valley

Are you ready to join Alianza Coachella Valley’s Youth Organizing Council? Fill out the Registration form and have a parent or guardian complete the Consent Form below.

If you have any questions, contact Karina Andalon, Youth Programs Manager, at karina@alianzacv.org.

Submit your YO-C registration information using the form below. To complete your registration, you must download the YO-C Consent Form below, read it carefully with a parent or legal guardian, have your parent or legal guardian sign the form, and re-upload it using the link below. If you have any questions or issues, please contact Karina Andalon at karina@alianzacv.org.

Download the YO-C Consent Form (English)

Download the YO-C Consent Form (Spanish)

Upload your YO-C Consent Form(Required)

Max. file size: 2 GB.

Name(Required)

Phone Number(Required)

Personal Email Address(Required)

Date of birth(Required)

Home Address(Required)

Mailing Address(Required)

What is the name of the school you attend?(Required)

What grade are you currently in?(Required)

Parent or Legal Guardian Name(Required)

Parent or Legal Guardian Phone Number(Required)

Parent or Legal Guardian Email Address

Additional Emergency Contact Name

Additional Emergency Contact Phone Number

Additional Emergency Contact Relationship to Student

Any allergies, medical information, or accessibility accommodations that we should be aware of?

Any additional comments, questions, or concerns?