YBS Kids Membership Application
Membership for 6th-12th grade students is now open to individuals from all socioeconomic backgrounds who attend school or reside in the surrounding cities of Dallas and Collin County in North Texas. To apply, please ensure that all fields are completed.
Enter member’s information
Kindly enter the right information about the student
Member's Name
*
First Name
Last Name
Member's email address
*
example@example.com
Member's phone number
*
School District
*
Current Grade
*
Birthdate
*
-
Month
-
Day
Year
Date
Referred by a YBS Kids Member?
*
Please Select
YES
NO
We would like to cent!
If yes, please type first and last name
Referred By
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Parent/Guardian information
Contact Information
Parent/Guardian Name
*
First Name
Last Name
Cell Phone
*
Parent/Guardian's e-mail
*
example@example.com
Mailing Address
*
Street Address Line 2
City
Please Select
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District of Columbia
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Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
How do you hear about YBS Kids
*
Please Select
Google
Social Media
Word of Mouth
School Resource
Marketing and Advertisement
Signature
*
Please tell us what your child may be interested in learning more about:
Membership Fee
*
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1-year membership
The 1-year membership fee helps pay for the cost of essential services, including program resources and liability insurance.
$
55.00
Payment Methods
Debit or Credit Card
Please click one of the PayPal options to complete payment and
submit
the form.
Should be Empty: