BMIT / BWIT REGISTRATION

Register
youth.

Tell us about your young person, your family, and the support that would make a difference.

Need a hand? Call 503-853-1967

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A youth shaking hands with an adult in a BMIT jersey while another youth stands beside them.

Step 1 of 5: About your young person

About your young person

Start with the basics. BMIT and BWIT welcome young people ages 5–24.

Which organization are you registering for?

Black Men In Training (BMIT)
Black Women In Training (BWIT)

BMITBlack Men In Training BWITBlack Women In Training

Registration Date

Date of submission

Youth Name

First Name

Last Name

Youth DOB

Youth Age

Must be age 5-24

Youth Ethnicity

What makes them, them?

Help us understand their interests and the support they need.

School Name and Grade Level

Favorite Hobbies

Areas of Concern

Allergies/Health Conditions

Anything else you think we should know? Optional

Your family. Our community.

Give us a reliable way to reach your family.

Are Both Parents Present in Household?

Contact Info: Address

Street Address

Street Address Line 2 Optional

City

State / Province

Postal / Zip Code

Contact Info: Parent/Guardian

Parent/Guardian First Name

Parent/Guardian Last Name

Phone Number

Emergency Contact

Emergency Contact Phone Number

Ready for the next chapter.

Choose a shirt size, tell us your photo preference, and sign below.

Uniform (Shirt Size)

Photo Release Form

Yes AgreeNo Disagree

Signature

Draw your signature with a mouse, finger, or stylus. For help completing a signature, call 503-853-1967.

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Register youth.

Register
youth.