Community Partner Information Form

Thank you for being a CBEA Community Partner. As Covid rates continue to cause complications for our activities, we appreciate you taking the time to help us best protect all of our staff, volunteers, supporters, children, and families. We also would like to take this opportunity to update our records about your organization.

Organization Name

Organization Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Contact Name

First Name

Last Name

Email

Phone

(###)

###

####

Secondary Contact Name

First Name

Last Name

Email

Phone

(###)

###

####

What percentage of your athletes are vaccinated?

What neighborhood or neighborhoods do the majority of your athletes come from?

i.e. Marquette Park, Woodlawn, Citywide