The Allen Blash Foundation
Y.E.P. - 2025 Rise
Youth Empowerment Program Summer Camp
The Youth Empowerment Program (Y.E.P.) Summer Camp is a transformative overnight experience designed for middle schoolers, ages 10–13. Hosted annually by The Allen Blash Foundation, this camp empowers youth through dynamic programming focused on mental health, emotional intelligence, identity, leadership, and decision-making. Each year features a unique theme — with RISE 2025 centering on resilience, self-awareness, and empowered living.Led by Executive Director Nick Blash and supported by a team of trained mentors and youth development specialists, Y.E.P. combines outdoor adventure, hands-on workshops, and character-building moments to help youth thrive emotionally, socially, and academically. This safe, high-energy environment is rooted in community, reflection, and belonging — helping students rise to meet their full potential.
Parents Name
*
First Name
Last Name
Contact Number
*
Format: (000) 000-0000.
E-mail
*
example@example.com
Full Name of Child:
*
First Name
Last Name
Relationship to Child
*
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Grade Level
*
(Right Now - Pre Summer)
Race / Ethnicity of student
*
Please Select
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Student T-Shirt Size
*
Please Select
Youth Small
Youth Med.
Youth Large
Youth XL
Adult Small
Adult Medium
Adult Large
What school does the student attend the current 2024-2025 School Year?
*
Is the student eligible for free or reduced lunch at school?
*
Please Select
Yes
No
Medical Information
*
Any Allergies or Medical Conditions (please specify): If none write N/A
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Relationship to Child
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Consent and Release Form for Youth Empowerment Summer Camp Program ParticipationBy signing below, I acknowledge that I am voluntarily enrolling myself/my child in the Youth Empowerment Summer Camp. I understand that this program is designed to provide academic support, mentorship, and extracurricular activities. I hereby consent to the following terms: Participation: I grant permission for myself/my child to participate in all Youth Empowerment Summer Camp activities, including, but not limited to, educational workshops, mentoring sessions, sports, field trips, and other recreational activities organized by the program. Medical Treatment: In the event of an emergency, I authorize program staff to obtain medical treatment for myself/my child if I am unable to be reached. I understand that I will be responsible for any medical expenses incurred. Media Release: I consent to the use of photographs, video recordings, and audio recordings of myself/my child taken during program activities for promotional and educational purposes by the Youth Empowerment Summer Camp. I understand these materials may be used in social media, newsletters, websites, and other promotional materials.Liability Waiver: I release the Youth Empowerment Summer Camp, its staff, volunteers, and affiliates from any liability for injuries, accidents, or any other incidents that may occur during participation in the program. I understand that every effort will be made to ensure a safe and positive experience for all participants. Data Collection: I understand that the Youth Empowerment Summer Camp may collect personal data—such as contact information and participation records—for program administration and reporting purposes. I consent to the collection and use of this information as outlined, with the understanding that it will be kept confidential and not shared with third parties without my permission.Behavioral Expectations: I acknowledge that myself/my child is expected to follow the rules and guidelines set forth by the Youth Empowerment Summer Camp to ensure a safe and productive environment. Failure to adhere to these expectations may result in dismissal from the program.
*
Type Full Name:
Signature
*
My Products
prev
next
( X )
Non-Refundable Application Fee
Y.E.P. Rise - 2025
$25.00
$
25.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
Submit
Should be Empty: