This application must be completed by Friday April 28, 2017.

YOU MUST BE A RESIDENT OF THE CITY OF KEENE
You must be 14 years old by June 30, 2017
 
Youth must complete application.  Answer all questions. Using a computer will give you a more professional and complete application.
 
If you need assistance with the process of filling out your application, please call: (603) 357-9811 or email at youthservices@ci.keene.nh.us . Youth Services is open Monday through Friday from 8am - 4pm.
 
 

* Summer Youth Information

* Date of Birth (mm/dd/yyyy)
You must be fourteen by June 30, 2017  and you can't be sixteen by June 30, 2017 to be in this program.

* Age
You must be fourteen by June 30, 2017  and you can't be sixteen by June 30, 2017 to be in this program.

* Parent/Guardian Information

* Second Parent/Guardian Information (if needed)

* School Information

* If yes, what department were you in last year?

* List any special conditions.  (Allergies, asthma, physical limitations, etc.)

* List dates and times that you WILL NOT be able to work from July 5th to August 11th

* Must list adult references: Give the name of an adult, who YOU know well, not related to you, such as guidance counselor, teacher, neighbor, student advisor, coach, clergy, etc.

* Must list adult references: Give the name of an adult, who YOU know well, not related to you, such as guidance counselor, teacher, neighbor, student advisor, coach, clergy, etc.

* Must list adult references: Give names of an adult, who YOU know well, not related to you, such as guidance counselor, teacher, neighbor, student advisor, coach, clergy, etc.

* I would work better in a(n)

* Please give an example or experience for each skill you possess and would like to utilize in the summer youth program.  Please list your specific skills.

Finished!  Thank you for applying for the Keene Summer Youth Program 2017!  You will receive an email confirmation from Survey Monkey that your application was received.  If you do not see this email please contact Youth Service at 357-9811 or email at youthservices@ci.keene.nh.us
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