Youth 360 Program Registration Form

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Youth 360 is a program designed to provide opportunity for students to build, create and explore!

Cohort 1 begins Saturday, September 20 - December 13, 2025

Hours - 10:00 AM - 12:00 PM

Location: Morning Star Baptist Church, 1512 Woodlawn Drive, Woodlawn, MD 21207

Eligible Students: Those entering grades 8 or 9 in the Fall 2025

(Spaces limited - early registration recommended)

Total cost of program: FREE!

Parent/Guardian: Please complete all of the questions listed below.

Child's Name: (First and Last Names) *

Male/Female

Child's Date of Birth *

YYYY

Parent/Guardian Name: *

Relationship to the child:

Student's Address: *

Parent/Guardian Phone Number: *

Parent/Guardian Email Address *

Emergency Contact Name: *

Emergency Contact Phone Number: *

Emergency contact relationship to the child: *

Does your child receive any special education/related services or behavior support? *

Yes

Required

If yes, please indicate below:

IEP

504 Plan

Other

None

Required

Medical: Does your child have any medical conditions/concerns? *

Yes

Required

If yes, please describe below:

Consent for photos: I give permission for photos to be taken for promotion and marketing purposes. *

Yes

Required

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