July 9th 11:30am-1:00pm Goodwill REC Youth Center located 1920 E Silverlake Rd. Suite 207 Goodwill Metro- Dating Violence Prevention Workshop Learn the signs of healthy versus unhealthy relationships and how to intervene safely if you know someone who may be experiencing an abusive relationship. Date MM slash DD slash YYYY Email* EmailName* First Last Over 18*YesNoThird ChoiceIf under 18, please have parent/guardian fill out consent information below Parent/Guardian Name First Last Parent/Guardian Email Arizona Youth Partnership will be presenting a dating violence prevention workshop in partnership with the One Love Organization entitled "Behind The Post". This workshop has been presented in schools and communities nationally as well as locally. It is a 60 minute workshop that helps you learn about healthy and unhealthy realtionships and how to intervene when someone may need help in a dating violence situation. All participants under 18 must have parental consent to attend. I give my child consent to attend:YesNoThird ChoiceParent Initials Date signed MM slash DD slash YYYY For mailing of participation incentive, please provide your mailing address: * Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Thank you for helping us fulfill our grant reporting requirements by providing the following:RACE/ETHINICITY*African AmericanAmerican IndianAsianWhiteHispanic/LatinoNative Hawaiian/Other/Pacific IslanderTwo or more racesUnkownGenderFemaleMaleNon-BinaryOtherPrefer not to discloseI would like to receive more information about AZYP programs*YESNOEmailThis field is for validation purposes and should be left unchanged.