YEA Program Interest Form

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YEA Program Interest Form

Parents, please complete this form if you are interested in registering your child(ren) for a YEA program. Please note that this is NOT an official registration form. Once this interest form is completed, a YEA staff member will reach out to you with details on how to register! If you have any immediate questions, please contact us at general@yea-inc.org or by calling (412)-273-0590

* Indicates required question

Parent/Guardian Name *

Your answer

Email *

Your answer

Address *

Your answer

Phone number

Your answer

Child(ren)'s Name

Your answer

Child(ren)'s Grade

Your answer

Child(ren)'s School

Your answer

Program(s) of interest *

AIM After School Program

Camp AIM Summer Program

Parent University Program

Other:

Required

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