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Youth Track
Registration
Youth Track – Schedule
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Parent & Professionals Schedule
Continuing Education
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Info
FAQ
LGBTQ Resources
Accessibility
Models of Pride 30 – Parent & Professional Registration 2022
david
2022-06-21T11:53:46-07:00
Parents & Professionals Registration
Are you registering as a Parent or a Professional?
*
Parent (or other family/adult supporter)
Professional (i.e. educator, therapist, etc)
First Name
*
Last Name must match that of your COVID-19 Vaccination Card or Negative PCR Test
Last Name
*
Email Address
*
Cell Phone
Birth Date
*
Current City of Residence
*
Current Zip Code
*
What is your profession?
Organization/Employer
I would like to receive a certificate request
I would like to receive a certificate of attendance please
Are you planning to obtain California Continuing Education hours? Credits are available for LAUSD staff, LMFT, LCSW, LPCC, and LEP licensures. A non-refundable $25 fee will be due below to complete your registration.
*
Yes
No
If you are planning to obtain California Continuing Education hours, which is your licensure level?
- select If you are planning to obtain California Continuing Education hours, which is your licensure level? -
LAUSD (Salary Points)
LMFT
LCSW
LPCC
LEP
Personal Gender Pronouns (she/her/he/him/they/zir/any)
*
Race
*
Black/African American
Latinx / Hispanic
Asian Pacific Islander
Caucasian (Non-Hispanic)
Native American
Multi Racial
Other
If other race, please specify in box below:
Gender Identity
*
Cisgender Woman
Cisgender Man
Transgender Man
Transgender Woman
Gender Queer
Nonbinary
Other
Other gender identity:
Sexual Orientation
*
Pansexual
Queer
Bisexual
Lesbian
Gay
Straight
Other
If other sexual orientation, please specify in box below:
How did you hear about Models of Pride? (select all that apply)
*
Previously Participated
Family told me about it
Friends told me about it
Through Work (Co-Worker, Supervisor, students, etc.)
Facebook
Instagram
Other (fill-in option)
If other, from whom/where?
We will do our best to provide assistance.
Do you need any of the following accommodations?
ASL interpreting (provide specifics in area below)
Alternative language translation (provide language in area below)
Accommodations details:
T-Shirt Size
XS
S
M
L
XL
2XL
I don't want a T-Shirt
Dietary Restrictions
Vegan
Gluten-Free
COVID-19 Proof of Vaccination
*
I will bring proof of my COVID-19 vaccination or a negative test.
By clicking "Yes" I agree to the Models of Pride Release of Liability.
Models of Pride Release of Liability
*
Yes
Release and Waiver of Liability
.
Optional Event Fees
Sponsor a youth!
Your donation of $35.00 covers the cost of one youth to attend Models of Pride. Every dollar counts so if you would like to donate more, please do so! Your donation helps keep this amazing event free for both Youth and Parents & Professionals.
Sponsorship Donation ($)
CA Continuing Education Fee
$25
Total
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