2019 Kansas YAG Student Registration
All students must complete this form by September 26. You must be in a delegation and complete all required fields to register for the program. You also must turn in the Student Code of Conduct Agreement Page and Medical Form to your delegation director.
PROGRAM AREA
Select the program area you plan to participate in at the Kansas YMCA Youth and Government State Conference.
Program Area *
OTHER PROGRAM OPPORTUNITIES
Would you be interested in participating in a Judicial or Media Program? If so, please indicate below. Judicial students would still participate in the Legislative Program. We will be looking to add a trial experience during the evening activities. Media members may exclusively serve in the media during the State Conference.
Other Opportunities
DELEGATION
Delegation *
If your delegation is not listed, please selected "Delegation Not Listed" and enter it in the text box below.
Delegation Not Listed
If your delegation was not listed, please enter it here
STUDENT INFORMATION
Please enter the following information. Your PREFERRED NAME will be used on your nametag.
First Name *
Preferred First Name *
Last Name *
This will be my _____ year in YAG.
Sex *
High School Graduation Year *
T-Shirt Size *
CONTACT INFORMATION
Street Address *
City *
State *
Zip
Home Phone
Cell Phone
Can YAG send you text messages?
Clear selection
Email
PARENT/GUARDIAN INFORMATION
Please enter information for a parent/guardian as an emergency contact for you.
Name
Relationship to you
Home Phone
Cell Phone
Work Phone
Email
Terms of Agreement *
I have reviewed the Student Code of Conduct and agree to abide by all the rules and requirements set forth by Kansas YMCA Youth and Government.
Required
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