Youth Initiative – Event Registration Form

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This form is to confirm your participation in our upcoming Journey of Action Youth Initiative events, designed to engage, inspire, and equip young people to lead with confidence and purpose.

3 events for 2 age groups in-person on June 28th in Utica and 1 event in Clinton on June 30th.

Please complete the form to stay informed and secure early access.

Email *

Participant's Full Name *

Parent/Guardian's Name (if under 18)
*

What Event would you like to register for? (Choose one)

Utica event on June 28th, 10 am for younger kids, 2 pm for teenagers

Clinton event on June 30th 11 am offered only for the age group 6-12yo

Required

Age Group (Choose one)

6–12 years old

13–20 years old

Required

Participant's Email

Parent/Guardian Email (if applicable)

Phone Number (parent/guardian if under 18)

What are your goals or hopes from attending?

Are you registering as part of a group, school, or organization?

Yes (please specify)

Maybe

Group/School/Organization Name

Would your group be interested in hosting a Youth Initiative event or partnering with us in the future?

Yes – let’s talk!

Maybe – please send more info

Not at this time

Would you like to receive updates about Youth Initiative events and programs in the future?

Yes

Photo/Video Release Permission (for virtual and in-person events)

I give permission to use participant’s image in promotional materials.

I do NOT give permission.

Additional Questions or Comments?

A copy of your responses will be emailed to the address you provided.

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