Civic Youth Leadership Program

Civic Youth Leadership Program - Enroll Now

CYLP Tentative Workshop Schedule: Sundays 3-5 PM on 1/12, 2/23, 4/6, 4/27, 5/4
Registering for*

Spring 2025
Student First name*
Student Last name*
Student Email
example@example.com
Student Phone Number
Please enter a valid phone number.
Age:*

10 - 1213 & up
Mother first name*
Mother last name*
Mother Email*
example@example.com
Mother Phone Number*
Please enter a valid phone number.
Father first name*
Father last name*
Father Email*
example@example.com
Father Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Civic Hub?*
I would love to join the program*
What best describes you?
What year are you?*
If you attend school/college, what is the name of your educational institution?*
If you are in college, what is your major?
How do you spend your free time?*
What are your top 3 strengths?*
What are your weaknesses?*
What is your favorite book?*
Biggest problem facing our community*
Youth issues*
What is a personal accomplishment you are proud of?*
Where do you see yourself 10 years from now?*
If you were to start a non-profit today what would it be?*
List any Allergies*
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)*
PAYMENT

Civic Hub

$249.00 Quantity

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Total

$0.00

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Enrollment Agreement
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Civic Youth Leadership Program - Enroll Now

PAYMENT

Enrollment Agreement