2026 Summer Youth Leadership Institute Registration Form

Parent/Guardian Information
Please have your parent or guardian fill out the following section, or complete it with them.
Parent/Guardian English Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email*
example@example.com
By providing us with your email or phone number through this form you authorize us to contact you by phone or email.
By checking the box below, you agree to receive text messages from the Korean Community Service Center at the phone numbers provided. Message frequency varies. Message & data rates may apply. Reply HELP for help. Reply STOP to opt out.
SMS Sharing Disclosure SMS

No mobile information will be shared with other parties for marketing/promotional purposes at any time.

Learn more about our 개인정보 처리방침 Privacy Policy

Emergency Contact Information
Emergency Contact Name *

First NameLast Name
Relationship to Youth*
Emergency Contact's Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

Medical Information

This information is confidential and will be referenced for in-person settings. You are welcome to share as much or as little as you would like.
Student Disability Accessibility Needs: We recognize that people have different abilities and needs. What do we need to be aware of to make this program accessible for your student? (Please email kcscyouthprograms@gmail.com if you would rather email this information)*

0/500
Food, medication or environmental allergies.*

0/500
Any physical, mental or other condition that would require special attention or medication?*

0/500
YesNo

Student Short Answer Questions

Please have the student fill out the following questions. We encourage you to answer these questions in your own words. Your responses do not need to be long. What matters most is that they reflect your voice, experiences, and perspectives.
Which of the five art forms are you most excited to explore, and why?*
What is something about your identity, background, or story that you'd like to express or share?*
How would you like to explore what you shared above through art?*
What would make this camp feel like a memorable and meaningful experience for you?*

Payment and Acknowledgement
I understand that Korean Community Service Center is unable to process refunds for this program.The student named above commits to attending Korean Community Service Center's 2026 Summer Leadership Institute from June 29 - July 3, 2026.

My Products*

2026 Summer Institute Registration Fee

This registration fee helps cover the cost of lodging. All other costs associated with this summer institute are offered free of charge thanks to competitive grant funding from King County Best Starts for Kids. If you are in need of a scholarship please email kcscyouthprograms@gmail.com. 이 등록비는 숙박비를 충당하는 데 도움이 됩니다. 이번 여름 프로그램은 King County Best Starts for Kids의 기금 덕분에 무료로 제공됩니다. 장학금 필요한 경우 kcscyouthprograms@gmail.com로 이메일을 보내주세요.

$250.00 Quantity
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KCSC Summer Institute Registration Form

Student Information

Parent/Guardian Information

Emergency Contact Information

Medical Information

Student Short Answer Questions

Payment and Acknowledgement

Credit Card