Youth Winter Camp

Matrix Youth Winter Camp

Complete the form to request more information
Welcome to our Matrix Youth Winter Camp pre-registration. The camp will take place at The Matrix Center from Thursday, January 2, to Saturday, January 4, 9 AM to 3 PM.

After completing this form, you will receive a pre-filled intake packet via Adobe within 72 hours. This packet must be signed and returned to complete your registration.

There are 75 spots available and will be filled on a first-come, first-served basis.
If you have any questions, please feel free to email us yapservices@matrixhs.org or call 313-938-0187.
Youth Name*

First NameLast Name
School*
Youth Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Youth Height (estimate)*
Youth Weight (estimate)*
Race*

Black/African AmericanWhite/CaucasianOther
Parent Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
How did you hear about Matrix Human Services*
Should be Empty: