YLC Summer Drop In - Registration Form

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YLC Summer Drop In - 2021 Details

Complete this form to register for Summer Drop In brought to you by Youth Leading Change

What: YLC Summer Drop In
Who: Current and incoming 7th-12th grade students
Where: People's Community Center, 1602 M.L.K. Jr Way, Tacoma, WA 98405
When: August 5th-August 26th, Tuesdays and Thursdays, 1pm-5pm

Program is FREE!
Lunch will be PROVIDED

PLEASE EMAIL rward@safest.org with any questions!

What is YLC Summer Drop In?
Drop in is a time and place for teens to come hang out, play games, shoot hoops, socialize, and hear/learn about resources in Pierce County. Lunch is at 1pm and is first come, first serve! Once open gym starts (at 3pm) teens are free to move between the open gym and our program space as they please!

Dates:
Thursday Aug 5
Tuesday Aug 10
Thursday Aug 12
Tuesday Aug 17
Thursday Aug 19
Tuesday Aug 24
Thursday Aug 26

First and Last Name *

Email Address *

Date of Birth *

YYYY

School (Incoming)

Enter the name of the school that the youth participant is attending or will be attending in September 2021

Incoming Grade Level *

Enter the school grade level that the youth participant will be in September 2021

8th grade

9th grade

10th grade

11th grade

12th grade

Home Address *

Example: 1234 S Pine St, Apt 567, Tacoma, WA 98405

Phone Number *

Hispanic Origin *

Select ONE option

Hispanic, Latinx, or Spanish Origin

NOT Hispanic, Latinx, or Spanish Origin

Prefer not to say

Racial-Ethnic Identity *

Check all that apply

American Indian or Alaska Native

Asian or Asian American

Black or African American

Native Hawaiian and Other Pacific Islander

White

My racial identity is not listed here

Prefer not to say

Required

Gender Identity

Check all that apply.

Female

Male

Trans female/ Trans woman

Trans male/ Trans man

Gender queer

Non-Binary

Questioning or unsure of gender identity

My gender identity is not listed here

Prefer not to say

Food Allergies/Diet Restrictions

Please list any accommodations needed. Write N/A if none.

Medical Allergies/Needs

Please list any accommodations needed. Write N/A if none.

Parent/Guardian First & Last Name *

Parent/Guardian Phone Number *

Parent/Guardian Email Address

Submit

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