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Youth Impact Collective Program Spring 2026 Registration
Please answer the questions below to complete your registration for the Youth Impact Collective Program at the Jackie Robinson Family YMCA Teen Center.
Parent/Guardian Name
*
First Name
Last Name
Participant Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Participant Email
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Date of Birth
*
-
Month
-
Day
Year
Date
Participant Date of Birth
*
-
Month
-
Day
Year
Date
Participant School
*
Which Fall Youth Impact Collective program are you interested in participating in?
*
ArtReach Teen Art Program (Fridays from February 20th, 2026 - April 24th, 2026)
IT Computer Wiz Kids Tech Enrichment Program (Saturdays March 7th, 2026 - April 18th, 2026)
We may go on occasional field trips in the Youth Impact Collective Program on Saturdays. If we do, there will be prior notice of the field trip to program participants and their parents/guardians. Are you interested in attending any potential Saturday field trips?
*
Yes
No
Not Sure Yet
Do you have any allergies or dietary restrictions?
*
Yes
No
If you have any allergies or dietary restrictions please list them below. If you have no allergies or dietary restrictions just write "None".
*
How did you hear about this program?
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YMCA Member
Email
Social Media
School
Other
We offer an application to apply for a 3 month membership scholarship for teens age 13-17 to help them meet their health and wellness goals. Would you/your teen be interested in filling out the application?
*
Yes
No
Submit
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