Summer Youth Program Application Form
Summer Youth Program Application Form
Please complete the form below to provide essential information for your child’s enrollment.
Participant Information
Name
Date of Birth
Age
Gender
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Male
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Female
Address
Guardian's Name
Phone number
Health Information
Does the participant have any allergies?
Does the participant have any medical conditions we should be aware of?
Is the participant taking any medications?
Physician's Name
Phone number
Program Participation and Consent
Preferred Program Activities
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Sports
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Fitness
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Arts & Crafts
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STEM
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Community Service
Liability Waiver and Release
I, the undersigned, as the parent/guardian of
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