Student Registration
Thank you for participating in Illinois YMCA Youth and Government! With this registration, you are registering for the following events, depending on where your school or Y is located. This form does not save your progress, so it must be completed in one sitting. You may need your name and phone number of your family physician and your medical insurance information.

Pre-Legislative Session 1: November 1st
Region 1- Neuqua Valley High School- Naperville, IL
Region 3- Williamsville High School- Williamsville, IL
Region 4- Sesser-Valier High School- Sesser, IL

Pre-Legislative Session 1- November 2nd
Region 2- TBD

Pre-Legislative Session 2- (TBD)
Region/Section 1- Lake Park High School, (East or West Campus TBD) - Medinah, IL

Pre-Legislative Session 2- (TBD)
Region 3/4- Section 3- Belleville West High School, Belleville, IL
Region/Section 2- Victor J Andrew High School, Tinley Park

Annual General Assembly
February 28th-March 1st- Springfield, IL

Please Complete this registration form. In addition, please be sure to print out Form D-2, Student Code of Conduct/Photo and Medical Release, which should be printed out and requires signatures and dates from both you and your parent or guardian, and give to your head advisor. The forms can be found on our website under the student registration section. Please confer with the Head Advisor or sponsor of your group for information regarding fees and scholarship information.
First Name *
Your answer
Last Name *
Your answer
Preferred First Name for Assembly Nametag *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Personal Email *
Put N/A if you do not have an email
Your answer
School Email *
Your answer
Cell Phone Number *
Your answer
Ethnic Background *
This information is used only to assess the diversity of the Youth and Government students being served. Please select responses from the choices below. (Supplying this information is voluntary - if you do not wish to give this information, please select "Decline to State." If selecting "Other", please use textbox to indicate ethnic background.
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