2018 Student Registration Form
All students must complete this form by September 17, 2018. You must be in a delegation and complete all required fields to register for the program. You also must turn in the Code of Conduct and Medical Form to your delegation director.
PROGRAM AREA
Select the program area you plan to participate in at the State Convention. All 9th grade students in the Legislative branch will be in the Novice House, if necessary. All 8th grade participants will be in the Civic Leadership Institute.
Program Area *
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
Your answer
STUDENT INFORMATION
Please enter the following information. Your PREFERRED NAME will be used on your nametag.
First Name *
Your answer
Preferred Name *
Your answer
Last Name *
Your answer
This will be my _____ year in YIG.
Sex *
Date of Birth *
MM
/
DD
/
YYYY
High School Graduation Year *
T-Shirt Size *
CONTACT INFORMATION
Be sure to enter accurate information so YAG can keep in contact with you about the program prior to the State Convention.
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?
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 Missouri YMCA Youth and Government.
Required
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