2025 CAPO Summer Break Camp - FOR Youth Program Application

FOR (Fortify Our Rebel) Youth

2025 Summer Break Youth Program Application
What is FOR Youth?

Fortify Our Rebel Youth (FOR Youth) is a program designed for teens aged 13-18 to connect, create, and grow in a safe and supportive environment. Through hands-on experiences in the creative arts, participants build friendships, develop new skills, and improve their mental and physical well-being. Along the way, they also explore business concepts, leadership opportunities, and ways to give back to their communities. Each year, we welcome 150 teens to join this exciting journey of self-discovery, creativity, and impact.
2025 FOR Youth & CAPO Summer Day Camp

MUSIC, PODCASTING, ZINES, YOGA, AND ARTS & CRAFTS

Location: CAPO

7944 W 3rd St Los Angeles, CA 90048

Dates: 6/16, 6/18, 6/20, 6/23, 6/25, 6/27, 7/7, 7/9, & 7/11

Monday, Wednesday, and Friday only (9 days total)

1:00PM-4:30PM

Contact: Tierra Strike

‭(323) 445-7946‬

tierrastrike@foryouthprogram.com

Lunch will be provided at each class.

Spaces are limited and we have 15 spaces available for youth ages 13-18.

Thank you for your interest in the FOR (Fortify Our Rebel) Youth Program! We value you, our community, and are excited to work together to deliver meaningful, high-quality programming for our youth.
Student Name*

First NameMiddle NameLast Name
Have you participated in our program before?*

YesNoApplied before
Student Information
Student Age*
Student Phone Number*
Student Birthdate*

MonthDayYear
Student Email*
Gender*

FemaleMaleGender FluidTransgenderNon-BinaryOther
LGBTQ?

YesNoPrefer not to answer
What is your shirt size (Adult size) ?*

XSSMLGXL2x3xOther
Where do you go to school?*
Grade in School Fall 2024*
School District*
Reduced School Lunch?*

YesNo
Special Diet Request*

VegetarianVeganNo porkOther
Any Food Allergies?*

NoYes
Race/Ethnicity*

LatinXBlack, African AmericanNative AmericanAsianPacific IslanderHispanicMulti-RacialWhiteOther
Are you a first generation immigrant?

YesNo
Are you or someone in your family a refugee?

YesNoFrom where?
Please tell us about yourself

This is a 9-day skill-building program for ages 13-18, where you’ll explore the creative arts, grow personally, and connect with others. To apply to FOR Youth Program, please answer the following questions. Spaces are limited, so try to answer the questions honestly and thoughtfully so we can get a clearer and more detailed understanding of who you are as an individual. There are no right or wrong answers to the questions – we’re simply trying to get to know you a little better. We look forward to learning more about you!
Have you been involved in creative or performing arts before? For example: acting, dancing, writing, painting, music, yoga, or any other forms of art. If yes, tell us about your experience. If you have other interests or skills, let us know too!*
Pick one word that describes you. Why did you choose that word? What makes it a good fit for who you are?*
What activities do you do regularly? This could be things like sports, clubs, creative projects, school activities, or volunteering. Tell us what you enjoy most about them.*
Your Well-Being
How important is your mental health to you? What do you do to take care of your mental health? (For example: journaling, talking to friends, exercising, etc.) What works best for you?*
How important is your physical health to you? What kind of activities do you do to stay physically healthy? (For example: playing sports, going for walks, stretching, etc.) What helps you the most?*
Why You Want to Join
Why do you want to be part of the FOR Youth Program? What do you hope to learn, experience, or gain through this program? How can we support you to reach those goals?*
Logistics & Contact Information
How did you hear about the program?(Examples: a friend, teacher, organization, Instagram, Facebook, etc. Please give names of FOR Youth participants, if possible.)*
Parent or Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
Parent/Guardian Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Household Income*

0-$12,000$12,000-$20,000$20,000-$30,000$30,000-45,000$45,000-60,000$60,000-75,000$75,000-$100,000$100,000+
Could applicant be classified as at-risk/at-promise?*

YesNoMaybe
Is applicant formerly incarcerated?*

YesNo
Is anyone in the family incarcerated or in a halfway house?

YesNoRelation to youth
Is applicant currently in foster care?*

YesNo
Does the participant have any physical or mental health conditions we need to know about? If they take any medications, have allergies, or need special accommodations, please list them here.*
How will the participant get to the program *
By which means: public transportation, family member, bike, etc.
Who will drop you off and pick you up? It’s important to arrive on time and be picked up promptly after each session.*
Permissions
Do you give us permission to use photos or videos of you for program promotions and to share with our funders?*

YesNo
May we share testimonials or survey responses for promotions or reports to funders?*

YesNo
Important Note: If your child misses the first day of programming without giving prior notification to the program manager, we will assign your child's spot to another student on the waitlist. Please initial below.*
Emergency Contact *

NameRelationshipPhone Number
Parent/Guardian Signature*

Clear
Thank you for applying! We look forward to reviewing your application and learning more about you. If you have any questions, feel free to reach out. Please follow us on social media and help spread the word!
Should be Empty:

FOR (Fortify Our Rebel) Youth

What is FOR Youth?

Student Information

Please tell us about yourself

Your Well-Being

Why You Want to Join

Logistics & Contact Information

Parent or Guardian Information

Permissions