2026 Mansfield Youth Services Registration Form

2026 Mansfield Youth Services Registration Form

This form is filled out for each youth 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 NameLast Name
DOB:
Gender:
Race:
Ethnicity:
Family Structure:
Free/Reduced Lunch:
Youth Phone Number (if applicable):
Address:

Street Address

Street Address Line 2

CityState / 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 NameLast Name
Parent/Guardian Phone Number:
Format: (000) 000-0000.
Parent/Guardian E-mail:
example@example.com
Relationship to Youth:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Parent/Guardian Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Youth:
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.
Middle School Programs
Summer Teen Center Hours: Drop in afternoons for Middle School teens. Tuesdays 12:30pm-4:30pm starting Tuesday, June 23, 2026. No sign-up needed, just drop-in to the Teen Center at MCC (yearly free teen center registration form required).
Mustangs Community Service Summer 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 4:30pm.
MMS Volunteer Program
Middle School Friday Teen Event
Circle Series
Mansfield Youth 4th-6th Grade Program
Mansfield Youth 4th-6th Grade Program
Teen Event
Middle School National Prevention Week Event (MAKE PICKUP SELECTION BELOW)
PLEASE COMPLETE IF REGISTERING FOR MMS SELF CARE FAIR
High School Programs
Summer Teen Center Hours: Drop in afternoons for High School teens. Thursdays 12:30pm-4:30pm starting Thursday, June 25, 2026. No sign-up needed, just drop-in to the Teen Center at MCC (yearly free teen center membership required).
Mustangs Community Service Summer 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 go to the Teen Center after, which is open for drop in hours until 4:30pm.
GOAL (Great Outdoor Adventure Learning) Summer program for rising 9th graders from Mansfield, Willington, Ashford. Wednesdays 9am-3pm (starting July 8, 2026 for 5 weeks).
School-Year Program
High School Friday Teen Event
Teen Event
Family Programs
Services
Pizza Kit Kick Off to Summer! All Mansfield families with at least one youth eligible. Please sign up for one pizza kit per youth. 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 kits you need. Pick up will be on Thursday, June 18, 2026 3-5:30pm at the Mansfield Senior Center at 303 Storrs Road in Mansfield. If gluten free dough is required, please email ysb@mansfieldct.org.
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.
Should be Empty:

2026 Mansfield Youth Services Registration Form

Youth Information

Parent/Guardian Information

Other Trusted Adults for Pick-Up

Which Mansfield Youth Services Program are you registering this youth for? Please check all that apply:

Middle School Programs

High School Programs

Family Programs

Permission to Participate

Acknowledgement of Safe Behavior

Waiver of Liability

Permission to Transport

Permission to Photograph