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Youth First Non-School Days 2020/2021 Registration Form
Please fill out one form per youth you are registering.
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* Indicates required question
Email
*
Your email
Participant Information
Participant First Name
*
Your answer
Participant Last Name
*
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Other:
Participant Nickname
Your answer
School
*
Oak View Middle School
Anoka Middle School (either campus)
Coon Rapids Middle School
Andover High School
Anoka High School
Coon Rapids High School
Northwest Passage High School
Other:
Grade 2020/2021 School Year
*
6
7
8
9
10
11
12
Age
*
11
12
13
14
15
16
17
18
Youth receives free/reduced lunch
*
Yes
No
Race/Ethnic Background (optional)
Black or African American
White
Hispanic or Latino
American Indian/Alaskan Native
Asian or other Pacific Islander
Other:
Clear selection
This is my ___ year in Youth First Programs
1
2
3
4
5
6
7
Clear selection
Participant Resides with:
*
Mother
Father
Both
Other:
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