Tell Us About Yourself – Power Up!

Tell Us About Yourself - Power Up!

Please share with us some information about what you hope to gain from the Power Up Program. In the event that we receive more applications than spaces available, these answers will be used to determine which youth should join the program.

Youth who are most eligible are those who may not have access to similar programming at school, in their community, those who could benefit from access to social programming with peers, leadership development and access to YMCA's facilties.

Name of youth participant *

First

Last

Phone

Email *

What are some activities, interests and hobbies you enjoy as a family?

Do you have any dietary restrictions we need to know about? (Eg. Halal, Gluten Free, Vegetarian, Lactose intolerant, allergies, etc.)

What are some interests and hobbies you enjoy when you have time for yourself?

What do you hope to gain from this program?

Returning Participants: How can we improve the program? What workshops and activities would you like to see?

Agreement *

I, the undersigned, hereby consent to my child's participation in the Power Up Program and release the YMCA and all subsidiaries from any liability that may arise through participation in said program.

know Do Vegetarian,

Date *

Signature of parent or guardian *