Youth & Government Membership 2023-2024

Youth & Government Membership 2023-2024

Late Fee Registration period
Club/School Name *
Please select your school or club name, If your school or club name is not in the options, please select school not listed at the bottom of the options listed. .
Welcome to OK YAG! We know this is going to be an awesome year and so glad you are apart of our Oklahoma Delegation! We are so thankful for organizations like Hatton Sumners foundation and The Oklahoma Bar Association give grant money each year to help fund our program! These gifts help lower the fee's for Membership and State Conference to our delegates/clubs. The membership fee is $25 and that covers Bill book, Red Book, marketing materials, Kick Off Retreat. Two District Conferences, Rallies, Supplies, and Snacks for the year. After filling out the registration form, your membership dues can be paid by the link at the bottom. If you have trouble with a card payment, please contact us asap. You may email toconnell@ymcaokc.org

Thank you
Please upload a school photo, or a photo of yourself (a cell phone selfie is great!)

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You can take a photo from your phone, or attach one from your camera roll, or files. Cancelof
{delegatestudentInformation} Information *

First NameLast Name
If school or club is not listed below, please list below.
{delegatestudentInformation} Email *
example@example.com
Gender*
Race or Ethnicity*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Pacific IslanderWhite or CaucasianHispanic or LatinoOther
{delegatestudentInformation} Cell Phone *

Area CodeCell Phone
{delegatestudentInformation} Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Please tell us your current age *
What grade are you currently in for the 2023-2024 school year*

FreshmanSophomoreJuniorSenior
Which District Conference will you be attending ?*

December 2nd Southwest District Conference - Southmoore HS (8:30am-3:30pm)December 9th - Northeast District Conference - Edmond North HS (8:30am - 3:30pm)I am planning on attending BOTH!
Emergency Contact information
{parentguardian1} Name *

First NameLast NameRelationship
{parentguardian1} Phone *

Area CodePhone Number
{parentguardian1} DOB*

MonthDayYear
Date
Parent Email*
example@example.com
Parent/Guardian 2 Name

First NameLast NameRelationship
{parentguardian2} Phone

Area CodePhone Number
How many years have you been in High School YMCA Youth & Government (including this year)*

This is my first year in Youth & Government2nd year delegate3rd year delegate4th year delegate
Did you participate in Model Legislative Day when you were in middle school/Jr. High ?*

YesNo
Please select what Branch you are in*

LegislativeMediaState OfficerLobbyistJudicial - Mock TrialJudicial - AppellateJudicial - JudgeGov. CabDistrict Youth Commission
Judicial Mock Trial Team - Who are the members on your team and what is your team name?
Example: Southmoore Team 1, Lawton Team 2
Appellate Team - Please list your Appellate team partner (if you do not have a partner please type NO PARTNER)
There may be many reasons you joined YAG, but what one sentence below BEST describes the reason you joined YAG.*

I have a sibling or family member that has been involved in YAG & suggested I joinMy friends talked me into itI have an interest in politicsI wanted to meet new friends and just joined because it sounded funI like to debateIt's something to add to my college application/resumeMy teacher suggested that I would be a great candidate for this programOther

Please read each statement below and tell us how well it describes you *

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
It is important to me to listen to and respectfully discuss political issues with my peers, even if we disagree
I believe State level policies affect people like me
I am interested in Politics, Policy, or Public Service and am already considering a career or college major in this area
I understand the requirements and specific steps to register to vote, when I become eligible

When you turn 18 do you intend to become a registered voter?*

I am already 18, and have registered to voteI am already 18, and have Not registered to voteYes!NoN/A
How important is celebrating and understanding diversity & inclusion to you?*

Very ImportantSomewhat ImportantSomewhat UnimportantNot Important at all
My level of involvement with volunteering in my community is*

Very InvolvedSomewhat InvolvedSomewhat UninvolvedNot Involved at allOther
I {{delegatestudentInformation},{parentguardian1}{parentguardian2} will read the following Waiver packet.

CODE OF CONDUCT

As a member of YMCA YOUTH & GOVERNMENT, I understand that

Mature and responsible behavior is expected from each student. Students should practice the four core values of the YMCA: caring, honesty, respect and responsibility.

I realize that safety is my first priority when participating in any YAG event.

I will respect the rights and personal properties of others at all times
The use of appropriate language are expected at all times during YAG events

I understand that the personal use of cell phones, tablets, ipods, gaming devices, smart watches, ear phones/buds, or any other technology must be silenced and put away during specific activities.

I will be respectful, responsible in my use of social media, including but not limited to; Facebook, Instagram, Twitter, Snap Chat, taking photos, and texting.

HOLD HARMLESS AGREEMENT

By my signature (at the bottome) and of my free will, ( {delegatestudentInformation} and {parentguardian1}, {parentguardian2}do hereby agree to indemnify and hold harmless of the YMCA of Greater Oklahoma City from all claims or demands, costs or expenses arising ou of any injuries, damages or other losses, whether personal or property sustained by me or any party to whim I am responsible.

PHOTO, VIDEO/AUDIO RECORDING RELEASE

For my participation in activities conducted by the YMCA of Greater Oklahoma City, I hereby give permission and consent, now and for all time, to the YMCA of Greater Oklahoma City, the National Council of Young Men’s Christian Associations of the United States of America (YMCA of USA) and third parties collaborating with the YMCA of Greater Oklahoma City and/or YMCA of USA to make, reproduce, edit, broadcast or rebroadcast any video film, footage, sound track recordings and photo reproductions of me and/or my dependent. My narrative account of my experience at the YMCA of Greater Oklahoma City may be used for publication, display, sale or compensation to, and/or claim. I may, or may not be, identified in such reproductions; however, I shall not be stated by name to have endorsed a particular commercial product or commercial service.

AUTHORIZATION FOR EMERGENCY MEDICAL CARE

In case of an emergency, we will contact {parentguardian1} at {parentguardian18}. If {parentguardian1} and {parentguardian2}, we give consent for {delegatestudentInformation} to be transported to the nearest hospital
By signing this I have verified that I, {delegatestudentInformation} and {parentguardian1} have read and agreed to the Hold Harmless, Authorization for Medical Care, Photo/Video/Audio recording Release, and Code of Conduct. *

Clear
MEMBERSHIP DUES - In order to complete registration, the payment must be submitted :)*
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Youth & Government Membership -o$40.00
Your membership dues cover the YAG Kick off day, Districts Conferences, Zoom meetings, Red Book, Bill Book/Trial Book, rental of facilities and equipment, supplies, and food for events

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