Cesar Chavez Youth Leadership Conference (CCYLC) 2019
 
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CCYLC Information
Please complete this registration form for each family attending this event.  

CCYLC Student Supplemental Registration Form: https://goo.gl/8FtyKb

We ask each participating (middle school, high school, and college) student complete the following CCYLC Student Registration Form and return to our trip chaperone:
Heriberto Soto [heriberto.soto@twinriversusd.org].

We appreciate your cooperation in completing all these steps no later than March 8, 2019

Bus Schedule and Directions
We'll start loading at 8:30 AM, and depart at 9:00 AM from the Life Center at Logan Park Apartments.
We will leave UC Davis by 3:00 PM and arrive at Logan park Apartments by 3:30 PM.

For directions to the pick-up location, click here: https://goo.gl/maps/5XSe9XXHyps 
Life Center @ the Logan Park Apartments
Address: 4141 Palm Ave, Sacramento, CA 95842
CCYLC 2019 Flyer
For more information on CCYLC 2018: www.ucdavis.edu/sisepuede 
PARENT/GUARDIAN(S) INFORMATION
Parent/Guardian #1
Name *
Parent/Guardian will... *
Required
Parent/Guardian #2
 Name
Parent/Guardian will...
Contact Information
Preferred Phone Number *
Mailing Address *
Email Address
STUDENT INFORMATION
Student #1
Name *
Date of Birth *
Month/Day/Year
MM
/
DD
/
YYYY
Gender *
Race/Ethnicity *
School Attending *
Current Grade Level *
Shirt Size *
Student #2
Name
Date of Birth
Month/Day/Year
MM
/
DD
/
YYYY
Gender
Race/Ethnicity
School Attending
Current Grade Level
Shirt Size
Student #3
Name
Date of Birth
Month/Day/Year
MM
/
DD
/
YYYY
Gender
Race/Ethnicity
School Attending
Current Grade Level
Shirt Size
Student #4
Name
Date of Birth
Month/Day/Year
MM
/
DD
/
YYYY
Gender
Race/Ethnicity
Current Grade Level
Additional Participants Attending (May Include Younger Siblings)
Name, School Site, Date of Birth, Gender, School Site, Grade Level, etc.  
For more information:
Crystal Harding-Jenkins
Black Child Legacy Campaign
Mobile: 916-900-6707
crystal@libertytowers.org 
www.impactsac.org

Danbaki Johnson, Executive Director at Life Matters, Inc.
Mobile: 916-905-3550 Office: 916-304-3564
djohnson@wherelifematters.com
https://wherelifematters.com/ 

Heriberto Soto
Parent Engagement Educator
Student Engagement Department-Family and Community Engagement Team
(916) 566-1600 Ext. 32214
heriberto.soto@twinriversusd.org 
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