Teens Light Club Registration

Register for our next Light Club event for teens (ages 14-19). Our meetings take place every second Wednesday of the month from 7:15-8:15pm CT.

NO-COST REGISTRATION

"*" indicates required fields

Name*

First Last

Parent/Guardian Name*

First Last

Parent/Guardian Email*

Parent/Guardian Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Gender*

Female

Nonbinary

Male

Other

Birthday*

Have you attended a Light Club meeting before?*

Yes

Which parent has been diagnosed with younger-onset Alzheimer’s or other dementias and for how long has your family been living with this diagnosis?*

How would you describe your family's experience with this diagnosis?*

In what ways do you hope Lorenzo's Light Club will support you and your family's journey?*

Consent*

I agree to the privacy policy.

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