CIC Family Outreach Program Sign Up
Non-profit organization Children of Incarcerated Caregivers (CIC) is teaming up with the Minneapolis
YMCA to offer free, fun programming to children who have been impacted by parental incarceration. The program is open to Minnesota children ages 8-14.

The goal is to create opportunities that encourage their success and allow them to thrive. Children will earn points for each programming event they participate in with the goal of earning enough points to attend YMCA summer camp for a week in 2021 at the magical Camp Icaghowan for FREE!

Our programming will focus on the following areas:

• Nutrition Education
• STEM (science, technology, engineering and mathematics)
• Financial Literacy
• Mentorship (Brotherhood/Sisterhood)
• Special Family Events
• Sports & Swimming Lessons
• Caregivers’ Support System

Please fill out one form for each child. No information will be sold or shared. If you have any questions as you fill out this form, please contact our Community Outreach Coordinator Tricia Alexander at outreach@cicmn.org.

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Email *
Child's Information
Please complete one form for each interested child.
Child's first name: *
Child's last name: *
Child's birthday: *
MM
/
DD
/
YYYY
Child's grade for the 2020-21 academic year: *
If answered "other" for grade level, please specify below (Put N/A if selected grade level above): *
Child's race/ethnicity (Please select all that apply): *
Required
Child's gender: *
Child's interests (Select all that apply):
Caregiver's/Parent's Information
First Name: *
Last Name: *
Phone Number: *
What day(s) of the week are you available for a virtual caregivers meeting? *
Required
What time(s) of day are you available for a virtual caregivers meeting? *
Required
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