IACS Youth Outreach Registration

IACS YO Registration for 2024-25 Program Year.

Parent Email*

This parent contact will receive all confirmations.
YO Name*
First Last
Age*
Birthdate*
MM slash DD slash YYYY
Gender*
YO Applicant Pronouns*
School*
Grade Sept 2024*
YO email required (parents pls do not add your email)*

Parents, please don’t add your email. We do need applicant’s email for communication as well as for Youth Advisors to provide mentorship and check-in.
YO's mobile #
Parents, please do not add your phone number. If the YO applicant doesn’t have a cell phone, just leave it blank.
Meal Preference*
Food Allergies*
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*