Junior Youth Legislature Intent to Participate

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LAST FRIDAY IN JANUARY

Parents/students complete this form to indicate interest in participating in Junior Youth Legislature (JYL), a program sponsored by the Alabama YMCA.

Email *

Student Name *

Student NON-SCHOOL (personal) Email
*

Enter a NON-school personal email address here. If you do not have one, please create one. We recommend that you don't use silly/character names but instead use some form of your name to create a professional-sounding email address. The school email system prevents you from receiving emails from persons outside the school system including the YMCA.

Student Grade
*

6th

7th

8th

Student School
*

Centre Middle

Cedar Bluff

Gaylesville

Sand Rock

Spring Garden

Student Cell # (area code included)

Parent/Guardian Name
*

Parent/Guardian Cell # (area code included)
*

Parent Email
*

Parent Permission (check all that apply)
*

I will drive my child and remain at the conference (adult registration required, lunch incl.)

I will drive my child but will NOT remain at the conference (lunch NOT included)

I am willing to transport other students if necessary.

I would like a financial assistance application.

I have additional questions and would like more information.

Required

A copy of your responses will be emailed to the address you provided.

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