IACS Young Adult and Youth Advocacy Registration

IACS Young Adult & Youth Advocacy (YA) Project Based Registration

IAWW/IACS

Parent email*
Applicant Name*
First Last
Age*
Birthdate*
MM slash DD slash YYYY
Gender*
Applicant Pronouns*
School*
Grade*
Please select your current grade
Applicant Email*
Enter Email Confirm Email

Parents, please do not enter your email in place of your child's email.
Applicant's mobile #*
What are you interested in working on? Mental Health/wellness Advocacy; Civic Engagement; Climate Change; Racial Equity, Women's Rights, Youth Council Waitlist, Peer Tutoring/Mentoring*
Mental Health and Wellness Advocacy work Racial Equity Climate Change Peer Tutoring/Mentoring on Sundays via zoom Youth Council Waitlist Other area in the organization (please list)
Home phone*
Home address*
Street Address City ZIP Code
Mother's name*
Mother's Email*
Mother's cell*
Father's name*
Father's email*
Father's cell*
Youth/Young Adult's Initials for Zero-tolerance policy*
Grounds for Immediate Dismissal : IAWW has a zero-tolerance policy for smoking, vaping, alcohol, and illegal substances (even if something is legalized, it is still illegal for under 21) By entering your initials above, you acknowledge that you understand the guidelines above and that failure to meet the requirements will result in your dismissal from the program.
Young Adult's initials or if minor: Parent Initials- consent for photos and videos*

I give permission and consent to IAWW to take photographs and videos of my child that would be published and used to illustrate, report, promote, and advertise programs and events. Examples of these are photos/videos at community service projects, meetings, panels, events, and camp. If you do not give us permission then instead of your initials, pls say that in the above field.

IACS Young Adult & Youth Advocacy (YA) Project Based Registration

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