Human Library “Book” Registration

Fields marked with an <span class="ninja-forms-req-symbol">*</span> are required

Deadline is Monday, March 22nd, 2019

Name *

Your Email *

I am comfortable with my photo and information being available on the Grand River Health Communities website, Brantbelievesin Instagram, and other material as a method to promote the Human Library. *

• Yes
• No
• Need more information for my decision

Is there a particular way you would prefer to be referred to as a your “Human Book” demographic? (i.e. youth, newcomer, person with lived experience of mental health, senior, experience with substance use, etc.) *

Please tell us a bit about yourself and why you represent the demographic you have chosen. *

Please describe past life experiences, within your demographic, that you feel members of the community would like to learn about: *

Why do you think it is important for people to learn about your topic: *

Do you have any dietary restrictions or other special accommodation requests we should be aware of for planning purposes? (e.g. allergies, technology, assistance, changeroom, etc.) *

Please indicate below your availability for the event day (minimum requirement one (1) hour between 10am-4pm): *

Please indicate your preference for the following items:

Please indicate your preference for the following items:

Preferred gender pronoun: *

• She
• He
• Zhe
• They

Other:

General availability for one weekday training session a week before the event: *

• Evening
• Afternoon
• Morning
• only available for event

I am comfortable with my email address being shared with the other Human Books (a maximum 15 individuals) for purposes of being able to connect with each other before and/or after the event to build community and share thoughts/concerns. This is not mandatory to be Book. *

• Yes
• No
• Need more information for my decision

If you are a human seeing this field, please leave it empty.