Application for YOUTH TAKING AUTHORITY (YTA)

PEOPLE OF PURPOSE COMMUNITY DEVELOPMENT CORPORATION

Please complete this form for the organization for the current year. Youth Taking Authority Program requires all individuals to register for participation in the Organization annually. The registration fee must be paid at time of enrollment to secure spot. Program/Activities fees will apply for services.

DATE
DATE
PARENT’S NAME *
PARENT’S NAME
ADDRESS
ADDRESS
PHONE
PHONE
PLEASE LIST NAME OF CHILD OR ALL CHILDREN THAT WILL BE ENROLLED IN THE PROGRAM.
DOB
DOB
DOB
DOB
DOB
DOB
DOB
DOB
EMERGENCY CONTACTS
CELL
CELL
CELL
CELL
AREAS OF INTERESTS: Below are programs and activities People of Purpose and its partners offer to youth and families in our communities. Please check all that apply:
Out of School Programs:
Education:
Creative Arts
Recreation
Visual Arts
Computer Science
Other
*
*
*
*
*
*
DATE *
DATE