Youth Winter STREAK
The Youth Winter STREAK Wellness Program is a FREE 11-week youth program for youth in Chambersburg and Shippensburg. We are encouraging you to increase their physical activity, eat healthy, and reduce stress. Plus, you can win prizes! For more info, go to
Youth's Name (First and Last)
Parent/Guardian's Name (First and Last)
Mailing Address (If you win a gift card, where should we mail it?)
What School District do you attend or live in if you attend a private school/homeschooled?
Chambersburg Area School District
Shippensburg Area School District
What is your Current Grade?
Do you (youth) attend/participate in:
Boys and Girls Club of Chambersburg
Boys and Girls Club of Shippensburg
Check & Connect
Shippensburg Teen Leadership Club
None of the above
By entering my name below, I give permission for my photo or video (or child's photo or video) to be posted on the Youth Winter STREAK website and social media related to this program. (Leave blank if you do NOT want your photo or video shared).
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This form was created inside of Shippensburg University.