Delta Youth Programs Application

Delta Youth Programs Application

Kansas City (KS) Alumnae Chapter
What Youth Program are you applying?*
Are you returning participant?*
Participant Information
Participant Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Participant Date of Birth*

MonthDayYear
Date
Participant Age*
Email*
example@example.com
T-Shirt Size*
Are there any activities that would prevent you from fully participating in activities in September - May?*
School Information
School Name*
Grade Level for the Fall School Year*
Parent / Legal Guardian Information
Parent / Legal Guardian #1 Name*

First NameLast Name
Parent / Legal Guardian #1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Legal Guardian #1 Cell Phone Number*
Please enter a valid phone number.
Parent / Legal Guardian #1 Home Phone Number*
Please enter a valid phone number.
Relationship to Participant*
Parent / Legal Guardian #1 Email*
example@example.com
Parent / Legal Guardian #2 Name

First NameLast Name
Parent / Legal Guardian #2 Address (if not the same as above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Legal Guardian #2 Cell Phone Number
Please enter a valid phone number.
Parent / Legal Guardian #2 Home Phone Number
Please enter a valid phone number.
Relationship to Participant
Email
Parent / Legal Guardian Signature*

Clear
Date*

MonthDayYear
Today's Date
If you have any questions, please contact the Youth Program subcommittee Co-Chairs.

Delta G.E.M.S. send email to deltagems@dstkcks.org

Delta Academy send email to delta_academy@dstkcks.org

EMBODI send email to embodi@dstkcks.org

Please also note applications should be submitted by October 15, 2024 (Parent/applicant signature is required where specified). Applications not completed by the specified date will not be considered for acceptance into the Youth Programs for the upcoming year.
Should be Empty:

Delta Youth Programs Application

Participant Information

School Information

Parent / Legal Guardian Information