Youth Access Program – Nominator Form

Youth Access Program – Nominator Form 2025

Thank you for your nomination of a youth that you feel could benefit from a YMCA membership. It is our goal to break barriers and provide as much facility access as we can. Your nomination could be a pivotal moment in a youth's life.

This form is to be completed by the nominated Youth's community support person. Once completed the form will be directed to the Fredericton YMCA Outreach Team and you may be contacted to provide additional information.

Completing this nomination form does not guarantee the youth will receive a youth access membership. YAP Memberships are given out on a first-come-first-served basis.

Youth Information

Here you will provide us with some information on the Youth you are nominating.

Youth Name *

First

Last

Nominated Youth's Date of Birth *

Example: 7 January 2019

Nominated Youth's Email *

Why are you nominating this youth? How do you feel they would benefit from a YMCA membership? *

Nominated Youth's Parent/Guardian

Please provide us with the information for whom the nominee would consider their parent/guardian. If the youth is 19+, please enter NA in the responses.

Guardian Full name *

First

Last

Guardian Email *

Nominator Information

Here you will provide information on the nominator. The nominator is an adult community support such as a Youth Worker, Mentor, Teacher, Coach, Counsellor, etc. They will be contacted for an impact statement.

Nominator Full Name *

First

Last

Nominator Agency (Eg. Where they work, how they know the nominee) *

Nominator Email *

Next Steps

This form will be forwarded to the Outreach Team and should you need to be contacted, a member of our team will connect with you. Please feel free to email the team at yap@ymcafredericton.org with any questions regarding the process.

Thank you for your nomination!

The Fredericton YMCA Outreach Team.