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.
* Required
PROGRAM AREA
Select the program area you plan to participate in at the Kansas YMCA Youth and Government State Conference.
Program Area
*
Choose
Presiding Officer
Legislative - House
Legislative - Senate
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
Judicial
Media
DELEGATION
Delegation
*
If your delegation is not listed, please selected "Delegation Not Listed" and enter it in the text box below.
Choose
Kingman High School
Lawrence Free State High School
Shawnee Mission East High School
Shawnee Mission North High School
Shawnee Mission Northwest High School
Shawnee Mission South High School
Shawnee Mission West High School
Topeka High School
Wichita
Delegation Not Listed
Delegation Not Listed
If your delegation was not listed, please enter it here
Your answer
STUDENT INFORMATION
Please enter the following information. Your PREFERRED NAME will be used on your nametag.
First Name
*
Your answer
Preferred First Name
*
Your answer
Last Name
*
Your answer
This will be my _____ year in YAG.
Choose
1st
2nd
3rd
4th
Sex
*
Male
Female
High School Graduation Year
*
Choose
2020
2021
2022
2023
T-Shirt Size
*
Choose
S
M
L
XL
XXL
XXXL
CONTACT INFORMATION
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Can YAG send you text messages?
Yes
No
Clear selection
Email
Your answer
PARENT/GUARDIAN INFORMATION
Please enter information for a parent/guardian as an emergency contact for you.
Name
Your answer
Relationship to you
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Email
Your answer
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.
I agree
Required
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