Project Avary Online Group Preferences

Thank you for your continued interest in Project Avary, a community for children with incarcerated parents! This application is for youth who have already participated in our groups at least one time and are interested in returning again or for Avary outdoor participants who have been invited to attend an online session. For questions, please email claudia@projectavary.org or danielle@projectavary.org.

Youth Info

First Name

Last Name

Birthdate

Youth Pronouns

Pronouns

Youth Street Address

City

State

Zip

County

Please list after school/afternoon commitments (please include days and times)

Caregiver Details

Caregiver First Name

Caregiver Last Name

Caregiver Phone

Caregiver Email

Relationship to Youth

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Primary Session Request

August 19-September 26, 2024

October 28-December 12, 2024

Select Any Additional Sessions

August 19-September 26, 2024

October 28-December 12, 2024

Preferred Day

Monday 5:30pm PT	Tuesday 4pm PT	Tuesday 5pm PT	Wednesday 6pm PT
Wednesday 6:30pm PT	Thursday 6pm PT

Select Any Additional Days

Monday 5:30pm PT	Tuesday 4pm PT	Tuesday 5pm PT	Wednesday 6pm PT
Wednesday 6:30pm PT	Thursday 6pm PT

Anything else you would like to share with us? Any updates on the youth since their last group?

Are there any additional siblings new to the program that would like to apply?

Contact Information