Civic Youth Leadership Program
$199 for 8 sessions
Registering for
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Fall 2025 - Spring 2026
Student First name
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Student Last name
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Student Email
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example@example.com
Grade
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Number Only
Student Phone Number
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Please enter a valid phone number.
Mother first name
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Mother last name
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Mother Email
*
example@example.com
Mother Phone Number
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Please enter a valid phone number.
Father first name
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Father last name
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Father Email
*
example@example.com
Father Phone Number
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Please enter a valid phone number.
Home Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about Civic Hub?
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I would love to join the program
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Please Select
Online
In-person
Both Online and In-person
What best describes you?
Please Select
Grade 5-8
High School Student
College Student
Professional
Other
What year are you?
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Please Select
8th
9th
10th
11th
12th
Undergraduate Student
Graduate Student
Other
If you attend school/college, what is the name of your educational institution?
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If you are in college, what is your major?
How do you spend your free time?
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What are your top 3 strengths?
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What are your weaknesses?
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What is your favorite book?
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Biggest problem facing our community
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Youth issues
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What is a personal accomplishment you are proud of?
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Where do you see yourself 10 years from now?
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If you were to start a non-profit today what would it be?
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List any Allergies
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To make it easier for us to understand and accommodate you / your child(ren)'s needs, please add any additional Educational Information about your child below (i.e. ADHD, Dyslexia, etc.) We would like to ensure the safety and value of your child(ren)'s enjoyment at our Camps as much as possible. (Note: You may put "N/A", if applicable)
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PAYMENT
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Resource Fee
$
50.00
Civic Hub
$
199.00
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Last Name
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Enrollment Agreement
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Date of Consent
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