YEP Student-Parent Application 2023-2024

YOUTH EMPOWERMENT PROJECT After School

2023-2024 School Year
STARTING MONDAY SEPT 25TH

Monday - Friday (3 PM - 6 PM)
ALL MIDDLE SCHOOL & HIGH SCHOOL
Student Name*

First NameLast Name
Date of Birth*
School You Are Attending This Year*
What Grade Are You In?*
How Old Are You Today?*
Parent/Guardian Name You Live With*

First NameLast Name
If you could pick any career what would it be?*
TYPE CAREER CHOICE HERE
YEP APPLICATION 2023-24

PARENT SECTION
Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian HOME Number*

Area CodePhone Number
Parent/Guardian CELL Number*

Area CodePhone Number
Parent E-mail*
Are there any other medical, dietary or behavioral conditions we need to be aware of? If Yes, pls explain
Permission to Treat & Transport
Permission for Photo & Video Release
Should be Empty:

YOUTH EMPOWERMENT PROJECT After School