Action Team Spring 2021 Registration Form
This form serves as a student registration for participation in Youth Community Service's middle school leadership after school program, Action Team for the Spring 2021 semester.

Action Team will meet on Tuesdays from 4:00pm to 5:00pm online through Zoom. This semester long program will start on February 23rd and end on May 18th.

Please send a $120 registration fee along with filling out this registration form. Checks can be made out
to “Youth Community Service" and mailed to 780 Arastradero Rd., Room V-14, Palo Alto, CA 94306. Or you can pay with PayPal. If you would like to pay through PayPal, please provide an email to send a request to.
*Scholarships are available upon request.*

Thank you for your support of Youth Community Service and student service-learning. For more information about YCS, visit us at www.youthcommunityservice.org or check out our Facebook page!

Questions regarding this form may be submitted to Mickaela, mscoordinator@youthcoummunityservice.org.

*Note: This program used to be called SWAG (Students With A Gateway)
Student's School *
Student's Grade *
Student's Full Name *
Student's Home Address *
Home Phone Number *
Student's Birth Date *
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Parent/Guardian Contact Name *
Parent/Guardian Email Address *
Parent/Guardian Phone Number *
Parent/Guardian Employer *
Emergency Contact Name *
Emergency Contact Phone Number *
Are you able to pick up project kits once a month? *
What day(s) are you available to pick up project kits? Check all that may apply *
Required
What time are you available to pick up project kits? Check all that may apply *
Required
I, the parent/guardian of the above-named student, give permission for my child to participate in YCS program activities, including associated travel sponsored by Youth Community Service. In consideration of participation in this program, I hereby hold harmless Youth Community Service (YCS), its agents, employees and volunteers, from any injuries, accidents or losses, however caused, related to attending the activities, and agree to release all parties involved from any claim, lawsuit or damage which may arise as a result of or by reason of any injury, loss or accident. *
Type your name below to give permission:
I give my permission for YCS to use my child's picture, artwork, written work, and quotes for promotional materials. *
I am interested in volunteering at YCS activities.
Volunteering activities could include set up, chaperoning, running activities, etc. We will email you as needs arrive throughout the school year.
Clear selection
How did you hear about Action Team?
Questions, concerns, information, or feedback?
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