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2020 Middle School Registration Form
All students must complete this form by February 26.
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STUDENT INFORMATION
Please enter the following information. Your PREFERRED NAME will be used on your nametag.
School / Delegation
Your answer
First Name
*
Your answer
Preferred Name
*
Your answer
Last Name
*
Your answer
Sex
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Grade Level
*
Choose
7th Grade
8th Grade
T-Shirt Size
*
Choose
S
M
L
XL
XXL
XXXL
CONTACT INFORMATION
Be sure to enter accurate information so YAG can keep in contact with you about the program prior to the State Conference.
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
Your answer
Cell Phone
Your answer
Can YAG send you text messages?
Yes
No
Clear selection
Email
Your answer
PARENT/GUARDIAN INFORMATION
Please enter information for a parent/guardian as an emergency contact for you.
Name
Your answer
Relationship to you
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Parent/Guardian Email
Your answer
Terms of Agreement
*
I have reviewed the Student Code of Conduct and agree to abide by all the rules and requirements set forth by YMCA Youth and Government.
I agree
Required
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