Youth Empowerment Project Interest Form

Youth Empowerment Project Interest Form

Participant Interest Form. Thank you for your interest in the Dreamcatcher CRC Youth Empowerment Project! This free program is designed for Norwalk youth ages 12–24 who are interested in developing career skills, exploring creative arts, and improving their overall well-being. Program Start Date: October 2026 Cost: FREE Eligibility: Must be 12–24 years old and reside in Norwalk
Participant Name/ Nombre del Participante

First NameLast Name
Date of Birth/ Fecha de Nacimento

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age/ Edad
Phone Number (Participants 18 and over)/ Numero de Telefono (Edades 18+)
Please enter a valid phone number.Format: (000) 000-0000.
Email (Participants 18 and over) / Correo Electronico (Edades 18+)
example@example.com
Address/ Domicilio

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School/ Escuela
Grade/ Grado
Parent/ Guardian Information (Participants under 18) / Informacion del Padre o Guardian (Para participantes menor de edad)

First NameLast Name
Relationship to Participant / Relacion al Participante
Phone Number/ Numero de Telefono
Please enter a valid phone number.Format: (000) 000-0000.
Email/ Correo Electronico
example@example.com
Program Interest/ Programas de Interes
How did you hear about us?
For questions please contact Dreamcatcher CRC

More information on our website, dreamcatchercrc.org. We will contact you very soon! Más información en nuestro sitio web, dreamcatchercrc.org. ¡Nos pondremos en contacto con usted muy pronto!
Should be Empty:

Youth Empowerment Project Interest Form

For questions please contact Dreamcatcher CRC