Discovering Me Youth Summer Camp Enrollment Form

Welcome!

The Aya House Summer Discovery Program is a full-day, in-person summer experience designed for students entering 8th–10th grade in the Fall 2026 academic year (minimum age 13 as of July 13, 2026) who attend a school located in Wayne, Oakland or Macomb County. The program will take place Monday-Friday from 7:30 AM - 4:30 PM and will run July 13th - August 21st. Daily programs will take place at Aya House, located at 2055 Gratiot Ave, Detroit MI 48207.

This program combines structured academic learning, hands-on enrichment, financial literacy, and digital skill development in a supportive and culturally affirming environment that exposes them to career paths in social impact. Youth will engage in learning sessions, enrichment activities, supervised programming, and daily meals — all at no cost to families. We will also provide meals to participants and their families as well as transportation assistance to youth who need help getting to Aya House.

We are actively enrolling students until April 30, 2026. Space is limited to 100 students and pre-enrollment is required.

If you are the guardian or supportive adult for multiple, eligible students you may use this form to enroll each student. If you are not prepared to submit all details required for enrollment, you may save your draft and return to this form when you can complete all fields.

If you have any questions about the program, need assistance completing this enrollment form or would like to apply to be an instructor, email summerdiscovery@mifreedomcf.org.

Learn more at www.mifreedomcf.org/summerdiscovery

Student Full Name*

First NameLast Name

Student Date of Birth*

Must be 13 on or before July 13, 2026

Student Gender*

Student Race/Ethnicity*

Student Rising Grade Level (as of 2026-2027 Academic Year)*

Student School (as of 2025-2026 Academic Year)*

List the name of the school, if they are homeschooled or attend school online

Student T Shirt Size*

Does the student participate in or is the student eligible for any of the following (select all that apply):

Student Phone Number (Not Required)

Please enter a valid phone number.Format: (000) 000-0000.

Student Email (Not Required)

example@example.com

Address Where Student Will Reside July 13-August 21, 2026

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If your student has participated in Summer Discovery in prior years, please list their name, the year they participated, and the name of the host site

What extracurricular topics are most interesting to your student (Select all that apply)*

Guardian/Supportive Adult Full Name*

First NameLast Name

Parent/Guardian Cell Phone Number*

Please enter a valid phone number that can receive text messages and voice calls.Format: (000) 000-0000.

Parent/Guardian Email Address*

Relationship to Student*

Emergency Contact Name*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Relationship*

Does the student have any allergies? If yes, list them below.

Ex: peanut butter

Does the student take any medications? If yes, list the medication and dosage.

Ex: albuterol twice daily at 8 am and 2pm

Does the student have any medical conditions or physical/special needs? If so, list the condition/special need.

Ex: wheelchair bound

Referral Source: How did you learn about the Summer Discovery Program at Aya House?*

Additional Comments or Special Instructions

Ex: planned vacation days, late start, special requests, or visions for the program

Students who register for Summer Discovery programming must commit to attending programming throughout the summer. Summer Discovery is not a drop-in program, and it’s important for students to attend daily to receive the full benefits of the program. The Aya House Summer Discovery program will last 30 days and run from July 13th-August 21st. Will your student be able to attend at least 21 of the summer program days?*

YesI'm Not Sure

Which of the following will you need to ensure your student has a successful summer discovery experience (Select all that apply):

Discovering Me Youth Summer Camp Enrollment Form

Student Information

Guardian/Supportive Adult Information

Emergency Contact Information

Health and Medical Information