Student Information

Thank you for participating in Illinois YMCA Youth and Government! With this registration, you are registering for the following events, depending on where your school or Y is located.

Pre-Legislative Session I - November 2, 2018
Region 1 - Neuqua Valley High School - Naperville, IL
Region 3 - Williamsville High School - Williamsville, IL
Region 4 - Sesser-Valier High School - Sesser, IL

Pre-Legislative Session I - November 3, 2018
Region 2 - Victor J Andrew High School, Tinley Park, IL

Pre-Legislative Session II - December 7, 2018
Region 1/Section 1 - Lake Park High School, East Campus - Medinah, IL

Pre-Legislative Session II - December 8, 2018
Region 3/4 - Section 3 - Belleville West High School, Belleville
Region 2/Section 2 -Westmont High School, Westmont

Annual General Assembly
March 15-18, 2019 - Springfield IL

Please complete this registration form. In addition, please be sure to print out Form D-2, Student Code of Conduct/Photo and Medical Release, which should be printed out and requires signatures and dates from both you and your parent or guardian, and give to your Head Advisor. The forms can be found on our website www.ilymcayg.org under the Student Registration section. Please confer with the Head Advisor or sponsor of your group for information regarding fees and scholarship information.

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* 1. Name:

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* 2. Preferred First Name for Assembly Nametag

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* 3. Date of Birth:

Month/Date/Year

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* 5. Email Address (if you don't have an email, please put N/A in the first textbox):

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* 6. Cell Phone Number (if you don't have a cell  #, please put N/A in the textbox):

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* 7. Ethnic Background. This information is used only to assess the diversity of the Youth & Government students being served. Please select response from the choices below. (Supplying this information is voluntary - if you do not wish to give this information, please select "Decline to State." If selecting "Other", please use textbox to indicate ethnic background.)

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