Youth Summit Application Form

All fields are required.

Please complete and submit a separate form for each individual.

Student Information

Full Name:

Gender:

Age:

T-Shirt Size

Grade Level:

School Name

Email Address :

Phone Number:

Home Address

Any allergies/Restrictions:

Parent/Guardian Information

Name:

Relationship to Applicant:

Email Address

Phone Number:

Home Address

A parent information session will be held on Tuesday, April 7, from 10:00am to 11:00am. While attendance is not mandatory, we strongly encourage all parents to attend. Please check the box below if you'd like to attend.

Tuesday, April 7

Signature (Enter full name)

Agreement

(Check box to indicate acceptance.)

By submitting this application, I confirm that all information provided is accurate to the best of my knowledge. I understand that completion of this application does not guarantee acceptance into the Youth Summit.

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Youth Summit Application Form

Student Information

Parent/Guardian Information

Agreement