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2026 Mansfield Youth Services Registration Form
This form is filled out for each child in your family that will participate in a Mansfield Youth Services program. This form is NOT for Teen Drop-in Hours at the Teen Center. That requires a Teen Center Membership from the front desk of the Mansfield Community Center and is filled out once per year. If you need further assistance, please email ysb@mansfieldct.org. Thank you!
Youth Information
Youth's Full Name:
*
First Name
Last Name
DOB:
*
Gender:
Race:
Please Select
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White
Other
Ethnicity:
Please Select
Hispanic/Latino
Not Hispanic/Latino
Family Structure:
Please Select
2 Birth/Adoptive Parents
Step & Birth Parent
Single Parent (Female)
Single Parent (Male)
Grandparent(s)
Relative/Guardian
Foster Parent
DCF
Joint Custody
Emancipated/On Own
Other
Free/Reduced Lunch:
Please Select
Receives Free/Reduced Lunch
Eligible for Free/Reduced Lunch
Not Eligible
Rather not say
Youth Phone Number (if applicable):
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Allergies:
*
Medical/Psychological/Social information that may impact participation in programs for the Youth Services Team to be aware of:
Parent/Guardian Information
Parent/Guardian Name:
*
First Name
Last Name
Parent/Guardian Phone Number:
*
Format: (000) 000-0000.
Parent/Guardian E-mail:
*
example@example.com
Relationship to Youth:
*
Please Select
Mother
Father
Guardian
Other
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Parent/Guardian Name:
First Name
Last Name
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to Youth:
Please Select
Mother
Father
Guardian
Other
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
example@example.com
Other Trusted Adults for Pick-Up
Please provide contact information for trusted adults who may pick your child up from Youth Services programs. Please note, an ID may be required for pick up.
Rows
Full Name
Phone Number
1
2
Which Mansfield Youth Services Program are you registering this youth for? Please check all that apply:
Please note, some programs fill to capacity very quickly. Therefore, we enroll on a first come, first served basis. Your registration is only confirmed if/when you receive an email from a Mansfield Youth Services staff member with further details regarding the event. Please make sure to select the event you want to register for. A registration form without an event selected is not valid.
Elementary School Programs
After-School Club
Tiger Strong: Social-Emotional Movement After-School Club at MES for 3rd & 4th graders starting March 31, 2026. (Sign up through MES after school club sign up)
Middle School Programs
Middle School Friday Teen Event
MMS Volunteer Program
MMS Community Cares Youth Volunteer Program (must be referred by MMS staff to sign up)
COMING SOON-SUMMER: Mustangs Community Service Program for Middle School Tuesdays 9:30am-12:30pm (starting July 7, 2026 for 5 weeks). Teens enrolled in Mustangs, but also looking for a full day on Tuesdays can bring their lunch and be walked to the Teen Center after, which is open for drop in hours until 5:15pm.
COMING SOON-SUMMER: Middle School drop in afternoons for Middle School teens. Tuesdays 12:30pm-5:15pm starting Tuesday, June 23, 2026. No registration needed, just drop-in to the Teen Center at MCC.
Circle Series
Mother (or other important female caregiver) Daughter 5 Week Circle Series (January 15th, January 29th, Feb 12th, Feb 19th, March 5th) 5-6:30pm (Register by January 9, 2026)
Mansfield Youth 4th-6th Grade Program
Mansfield Youth 4th-6th Grade Program
Safe At Home Course February 17th 10:30am-12pm Booth & Dimock Memorial Library in Coventry
Teen Event
January 16th 3pm-5:30pm MIDDLE SCHOOL ONSITE - Cooking Class (FULL)
High School Programs
High School Friday Teen Event
School-Year Program
Smart Recovery Addiction Support for Youth (substance use, gambling, gaming, etc). Youth are able to self-refer.
Teen Event
***EVENT POSTPONED*** January 9th 2:30pm-5:00pm HIGH SCHOOL (ALL EO SMITH STUDENTS) OFFSITE: UConn Climbing Center - Meet at MCC Teen Center
COMING SOON-SUMMER: Mustangs Community Service Program for High School Thursdays 9:30am-12:30pm (starting July 9, 2026 for 5 weeks). Teens enrolled in Mustangs, but also looking for a full day on Thursdays can bring their lunch and be walked to the Teen Center after, which is open for drop in hours until 5:15pm.
COMING SOON-SUMMER: High School drop in afternoons for High School teens. Thursdays 12:30pm-5:15pm starting Thursday, June 25, 2026. No registration needed, just drop-in to the Teen Center at MCC.
COMING SOON-SUMMER: GOAL (Great Outdoor Adventure Learning) program for rising 9th graders from Mansfield, Willington, Ashford. Wednesdays 9:00am-3pm (starting July 8, 2026 for 5 weeks).
Family Programs
COMING SOON-SUMMER: Pizza Kit Kick Off to Summer! All Mansfield families with at least one youth eligible. Please sign up for one pizza kit per person. Kits are limited to first come, first served. We'd love to serve as many families as possible, so please be considerate of that when selecting how many you need. Pick up will be on Thursday, June 18, 2026 3-5:30pm at 303 Storrs Road in Mansfield.
Services
Parenting Support
Individual Youth or Family Counseling
Permission to Participate
I, the undersigned, give permission for myself or my child to participate in the above selected program(s).
*
Please type your name:
*
Acknowledgement of Safe Behavior
Please sign here acknowledging that your child will be expected to have safe behavior in Youth Services programs. Youth Services staff will help support your child to be safe to themselves and others. In the event that this is not possible, you will be contacted to pick up your child.
*
Waiver of Liability
I hereby agree to release, discharge, and hold harmless the Town of Mansfield, its directors, officers, employees, agents, contractors, and/or volunteers from any and all liability that may occur during either my participation or the participation of my minor child in the above listed recreational activities. I understand that participation in any recreational activity involves risk, and I grant permission to the Town of Mansfield to utilize any medical emergency services it deems necessary to treat any injuries that I or my minor child may incur. I further understand that the Town of Mansfield does not provide insurance for recreational program participants.
*
Permission to Transport
Please sign here if you give permission to Mansfield Youth Services to transport your youth in a vehicle owned by the Town of Mansfield where applicable for program purposes for all applicable dates in 2026. My youth understands that they will be expected to follow directions from staff to ensure safety and respect for all parties inside and outside of the vehicle including wearing a seatbelt at all times the vehicle is on.
Permission to Photograph
Please sign here if you give permission to Mansfield Youth Services to take photographs of your youth during programs. Photos of participants may be used to help others learn more about Youth Services programs. This may include display of photos in the Teen Center, on Mansfield Youth Services social media accounts, and/or Mansfield Youth Services program materials.
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