TEEN CENTER MEMBERSHIP FORM

The Teen Center at Youth At The Center is place where your voice is valued!

Sign up to become a Teen Center Member. Registration is Free and we will keep you updated on weekly activities and our monthly social events.
Member Information
First Name*
Last Name*
Age*
School*
Neighborhood*
Grade*
Email*
Phone Number*
How did you find out about the Teen Center?
Do you have any allergies or dietary restrictions?
Emergency Contact
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Media Release
MEDIA RELEASE: I grant permission for myself/my child to be photographed, audio-recorded, and/or videotaped for Youth at the Center (YATC) promotional and educational materials. I understand that this photograph, speech, or video may appear in various YATC publications. I also give permission for this material to appear on the YATC social media pages and websites (www.youthatthecenter.org / www.youngnotsilent.org)*

I agree
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Member Information