Art Discipline SelectionJEA will be virtual for the fall of 2020. If you were to rank your preferred art discipline, which would be your first choice?* DANCE MUSIC THEATRE If you were to rank your preferred art discipline, which would be your second choice?* DANCE MUSIC THEATRE If you were to rank your preferred art discipline, which would be your third choice?* DANCE MUSIC THEATRE How did you find out about our Jóvenes en Acción (JEA) program?* Music Clubhouse (MCH) Dance and/or Theatre at Hennigan or Margarita Muniz Academy Social Media School Presentation Flyer School Field Trip to HSTF Teacher Friend Opportunity Fair Viva Event Other Other:Participant InformationName:* First Last Date of Birth:* MM DD YYYY Age*Gender:* Female Male Non-Binary Gender Questioning Gender Transitioning Other If other, please specify:*Address:* Street Address Apartment Number (Write "N/A" if this does not apply to you) City State / Province / Region ZIP / Postal Code Home Phone Number:*Cell Phone Number:*Email Address:* Which of the following best describes you? Please choose one answer:* Asian or Pacific Islander Black or African American Hispanic or Latino Native American or Alaskan Native White or Caucasian Multiracial or biracial A race/ethnicity not listed here If other, please specify:*Country of Origin* Brazil Colombia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala Haiti Honduras Jamaica Mexico Panama Peru Puerto Rico United States of America Venezuela Other What school do you currently attend?* Academy of the Pacific Rim Boston Arts Academy Boston Collegiate Boston Community Leadership Academy Boston Green Academy Boston International School Boston Latin Academy Boston Latin School Boston Preparatory Boston Teacher's Union K-8 School Brighton High Brooke 8th Grade Academy Brooke High Burke High Charlestown High City on a Hill (Dudley) City on a Hill Codman Academy Conservatory Lab Curley K-8 Dearborn STEM Academy East Boston High Edison K-8 English High Excel Academy Excel High Fenway High Henderson K-12 Inclusion Hennigan K-8 Irving Middle Kennedy Academy for Health Careers 11-12 Kennedy Academy for Health Careers 9-10 Madison Park Margarita Muniz Academy MATCH Middle MATCH High McCormack Middle Mission Hill K-8 Murphy K-8 New Mission High Newcomers Academy O'Bryant Quincy Upper School Roxbury Preparatory Snowden International School at Copley TechBoston Academy Timilty, James P. Middle Tobin K-8 UP Academy Dorchester Urban Science Academy Young Achievers Science & Math K-8 Other If you selected "other" above, please write in the name of your school below.What grade are you in?*Parent / Guardian InformationParent / Guardian Name:* First Last Relationship to Youth:*Address:* Street Address Apartment Number (Write "N/A" if this does not apply to you) City State / Province / Region ZIP / Postal Code Home Phone Number:*Cell Phone Number:*Email Address:* Parent/Guardian Country of Origin* Brazil Colombia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala Haiti Honduras Jamaica Mexico Panama Peru Puerto Rico United States of America Venezuela Other Consent You have my consent.The information provided on this form is true and accurate to the best of my knowledge and I give permission for my son/daughter to participate in Hyde Square Task Force programs and activities.Parent / Guardian Signature:*Participant Signature:*Date:* Date Format: MM slash DD slash YYYY
