Molokai Youth Center Membership Form

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The Molokai Youth Center offers a variety of programs and activities for youths ages 8-17 (18 if in school) FREE of charge. MYC provides recreational, educational, and community service activities for all of the island's children.

Here are some of the Youth Center's programs:
*After school homework help *Recreational activities: pool and chess etc *Sports: volleyball, soccer and basketball etc *Music classes and recording *Art class *Cooking class *Excursion and camp outs *Community service kokua *Healthy snacks and meals *Leadership groups for younger and older kids.

To enroll your child please complete the form below. Mahalo!

Email *

Youth name *

Gender *

Female

Male

Age *

Grade *

Birth date *

YYYY

School *

Parent/Guardian name *

Phone number(s) *

Parent/Guardian name

Phone number(s)

Mailing address *

Allergy *

Yes

If yes, type of allergy

Medication *

Yes

If yes, type of medication

Emergency contact name and relation to youth *

Phone number (s) *

Medical insurance number

Type of insurance *

Physician name and phone number *

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