Youth Development Program Registration

1. Default Section

Please fill out the following information. You will receive an email confirmation of your registration once we have received and processed your application.

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* 1. Provide the following information for the youth who is registered for the YDP.

Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP/Postal Code: *

Country: *

Email Address: *

Phone Number: *

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* 2. Grade currently in or just completed

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* 3. Gender

Male

Female

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* 4. Date of birth

Date of birth

Date

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* 5. Provide parents' information

Fathers name

Fathers cell phone

Mothers name

Mothers cell phone

REGISTRATION FEES

For the yearlong YDP program, you will pay a flat rate of $35 per month. This fee includes all monthly outings, an individual committed mentor, special family events, and the opportunity to register for our invitation-only programs.

If you are registered multiple participants, the fees are as follows:
1st child- $35/month
2nd child- $35/month
3rd child- $30/month
All additional children- $30/month

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* 6. Registration Type

Individual Registration - $35/month

2nd Child Registration - $35/month

3rd+ Child Registration - $30/month

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* 7. Shirt choices
Mark the size of each type of shirt you want.

	X-Small	Small	Medium	Large	X-Large	XX-Large
Short sleeve T-shirt ($15)	Short sleeve T-shirt ($15) X-Small	Short sleeve T-shirt ($15) Small	Short sleeve T-shirt ($15) Medium	Short sleeve T-shirt ($15) Large	Short sleeve T-shirt ($15) X-Large	Short sleeve T-shirt ($15) XX-Large
Long sleeve T-shirt ($18)	Long sleeve T-shirt ($18) X-Small	Long sleeve T-shirt ($18) Small	Long sleeve T-shirt ($18) Medium	Long sleeve T-shirt ($18) Large	Long sleeve T-shirt ($18) X-Large	Long sleeve T-shirt ($18) XX-Large

Question Title

* 1. Provide the following information for the youth who is registered for the YDP.

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* 2. Grade currently in or just completed

Question Title

* 3. Gender

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* 4. Date of birth

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* 5. Provide parents' information

Question Title

* 6. Registration Type

Question Title

* 7. Shirt choicesMark the size of each type of shirt you want.

* 7. Shirt choices
Mark the size of each type of shirt you want.