2023 State YMCA Youth and Government Participant Application

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Welcome to the STATE YMCA OF MAINE'S YOUTH AND GOVERNMENT PROGRAM.

Email *

FIRST NAME *

Name you would like on Name Tag, and seat card

LAST NAME *

GRADE *

YEARS ATTENDING YOUTH AND GOVERNMENT *

GENDER *

SCHOOL OR YMCA YOU WILL REPRESENT *

What Committee would you like to be on choice 1 *

What Committee would you like to be on choice 2 *

What Committee would you like to be on choice 3 *

YOUR CELL PHONE

Not required we will only use to contact you via text or call pertaining to Youth and Government

MEDICATION OR MEDICAL INFORMATION WE SHOULD KNOW ABOUT

Dietary Concerns

Gluten Free, Vegan, Vegetarian etc, so we can make sure we have food for you.

Parents Names *

Home Address *

Town *

Zip Code *

Home Phone *

Need this in order to contact in case of emergency

I HAVE READ AND AGREE TO ADHERE TO THE YOUTH AND GOVERNMENT CODE OF CONDUCT *

You need to read and understand that we require all participants to adhere to the Code of Conduct, Dress Code, Hotel Policies, and all parts of this agreement.

I AGREE

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

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