IACS Youth Outreach Registration Youth Outreach Enrollment 2025-2026 Please complete below information and submit this form before 09/21/2025, 11:59 PM, to confirm your spot in Youth Outreach Program for 2025-2026. If you have any questions, please email at -ylpinfo@iaww.org. PhoneThis field is for validation purposes and should be left unchanged.YO Applicant Name (Child's name)(Required) First Last Applicant Email *(Required) Applicant's Phone *(Required)Website https://buy.stripe.com/00w9ATfdD9nl4vAdURdIA01Address(Required) Street Address Zip Code(Required)Home Phone numberSchool(Required)Grade in Fall of 2025(Required)67Age (on Oct 1, 2025)(Required)111213Birth Date(Required) MM slash DD slash YYYY Gender(Required)FemaleMaleNon-BinaryPrefer not to sayPronoun(Required)he / himshe /herthey/themMeal Preference(Required) Vegetarian Non-Vegetarian Vegan Allergies (Food, Medicine, other)(Required)Enter N/A if not applicableMother's name(Required) First Last Mother's Email(Required) Mother's Cell Phone(Required)Company/Organization (Mother)Father's name(Required) First Last Father's Email(Required) Father's Cell Phone(Required)Company/Organization (Father)Untitled Would you like to volunteer with us for any of our events/programs? Youth Outreach Fees Price: Fees cover costs for Pizza and snacks when working outdoors, as well as other overheads. Operational costs for the program are covered by IACS.Would you like to add a donation to IACS?Would you like to offer a donation? Your generosity will directly support IACS crisis care services. $–$25.00$50.00$100.00Payment Method(Required) Zelle – preferred option ( Zelle id : iacszelle@iaww.org ) Credit card Total Credit Card CAPTCHA Δ
