Discovering Me Youth Summer Camp Enrollment Form

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 (minimum age 13) who live in Wayne, Oakland or Macomb County. The program will take place Monday-Friday from 8 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 1, 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 them. All students must reside at the same address from July 13-August 21, 2026 to be enrolled on the same form. A separate enrollment form is required for youth residing at a different address.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
Youth Information

Please provide details about the youth you are enrolling.
Number of Camper(s) Being Enrolled *
If you are the guardian or supportive adult for multiple, eligible students you may use this form to enroll them. All students must reside at the same address from July 13-August 21, 2026 to be enrolled on the same form. A separate enrollment form is required for youth residing at a different address.
Camper #1 Full Name*

First NameLast Name
Camper #1 Date of Birth*

MonthDayYear
Must be 13 on or before July 13, 2026
Camper #1 Gender*
Camper #1 Grade Level (as of Fall 2026 Academic Year)*
Camper #1 School (as of Fall 2026 Academic Year)*
List the name of the school, if they are homeschooled or attend school online
Additional Camper #2 Full Name

First NameLast Name
Additional Camper #2 Date of Birth

MonthDayYear
Date
Additional Camper #2 Gender
Camper #2 Grade Level (as of Fall 2026 Academic Year)
Camper #2 School (as of Fall 2026 Academic Year)
List the name of the school, if they are homeschooled or attend school online
Additional Camper #3 Full Name

First NameLast Name
Additional Camper #3 Date of Birth

MonthDayYear
Date
Additional Camper #3 Gender
Camper #3 Grade Level (as of Fall 2026 Academic Year)
Camper #3 School (as of Fall 2026 Academic Year)
List the name of the school, if they are homeschooled or attend school online
Additional Camper #4 Full Name

First NameLast Name
Additional Camper #4 Date of Birth

MonthDayYear
Date
Additional Camper #4 Gender
Camper #4 Grade Level (as of Fall 2026 Academic Year)
Camper #4 School (as of Fall 2026 Academic Year)
List the name of the school, if they are homeschooled or attend school online
Additional Camper #5 Full Name

First NameLast Name
Additional Camper #5 Date of Birth

MonthDayYear
Date
Additional Camper #5 Gender
Camper #5 Grade Level (as of Fall 2026 Academic Year)
Camper #5 School (as of Fall 2026 Academic Year)
List the name of the school, if they are homeschooled or attend school online
Additional Camper #6 Full Name

First NameLast Name
Additional Camper #6 Date of Birth

MonthDayYear
Date
Additional Camper #6 Gender
Camper #6 Grade Level (as of Fall 2026 Academic Year)
Camper #6 School (as of Fall 2026 Academic Year)
List the name of the school, if they are homeschooled or attend school online
Address Where Camper(s) Will Reside July 13-August 21, 2026*
Guardian/Supportive Adult Information

Contact information for the guardian or supportive adult aged 18 or older.
Guardian/Supportive Adult Full Name*

First NameLast Name
Relationship to Camper(s)*
Parent/Guardian Cell Phone Number*
Please enter a valid phone number that can receive text messages and voice calls.
Parent/Guardian Email Address*
Emergency Contact Information

Please provide an additional emergency contact in the event the guardian or supportive adult listed above is unreachable. This person must also be aged 18 or older.
Emergency Contact Name*

First NameLast Name
Emergency Contact Relationship*
Emergency Contact Phone Number*
Please enter a valid phone number.
Health and Medical Information

Provide any relevant health details about the youth you are enrolling. If you are not prepared to submit this detail, you may save your draft and return to this form when you can complete all fields.
Do any of the youth have any allergies? If yes, list the name followed by the allergy.
Ex: Marshon Williams, peanut butter
Do any of the youth take any medications? If yes, list the name followed by the medication and dosage.
Ex: Marshon Williams, albuterol twice daily at 8 am and 2pm
Do any of the youth have any medical conditions or special needs? If so, list the name followed by the condition/special need.
Ex: Marshon Williams, has asthma
Additional Comments or Special Instructions
Should be Empty:

Discovering Me Youth Summer Camp Enrollment Form

Youth Information

Guardian/Supportive Adult Information

Emergency Contact Information

Health and Medical Information