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The NEST Mural

Questions marked with a * are required

Registration

Please fill out the whole form. You will need both the youth/young adult and their parent/guardian to complete this form. You will receive a confirmation email once it is complete. If you do not receive the email, please reach out to Amos Wright at amos@ncidc.org or 707-445-8451 to confirm that we have received your registration.

Thank you for your interest in helping make our youth center, The Nest, a more welcoming and beautiful space for our community. Your help will greatly benefit our space and create a better sense of community. We look to work on the mural on Wednesday June 4th, 11th, and 25th.

All information provided on the form will be kept confidential and will not be shared with any external parties.

Youth/Young Adult Contact Information

First Name

Last Name

Youth/Young Adult Cell Phone

Email Address

Address Line 1

Address Line 2

City

Zipcode

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