Fresno County Annual Youth Summit
To apply for youth summit please complete all questions.
When: March 26th and 27th
Location: Wonder Valley Ranch
Must submit application by 3/15/2022
*Students are responsible for their own transportation, please email clinay@civicedcenter.com if you have questions or concerns.
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Email *
Full Name
School
Grade Level
Address
Phone Number
DOB
T Shirt Size
What Group will you represent?
Group Advisor Name
Group Advisor Email
Group Advisor Phone Number
Parent/Guardian Name
Parent/Guardian Number
Parent/Guardian Alternate Number
Medical Insurance Company
Medical Insurance Policy #
List of Medications
Allergy/Dietary Needs
CONDITIONS AND AGREEMENTS / WHAT YOU NEED TO BRING
You will get your own transportation to and from Wonder Valley. (Arrive 8:30am, 3/5, and depart 4pm, 3/6)
You will show proof of vaccination or negative COVID test, within 3 days of arrival, and agree to wear a mask indoors.
We will follow current CDC guidelines.
You will get your parent/guardian to sign the CEC Release Form.
Bring clothes for two days, including winter coat, Pajamas, and toiletries.
Water bottle, face mask, and sunscreen.
Recommended: camera, journal

Contact: Clinay Wills at CEC for more information; Clinay@civicedcenter.org
www.civicedcenter.org
A copy of your responses will be emailed to the address you provided.
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