2018 State YMCA Youth and Government Participant Application
Welcome to the STATE YMCA OF MAINE'S YOUTH AND GOVERNMENT PROGRAM. Complete this form and you will receive a confirmation email, and program information within the next few days.
You are the most important part of our program please make sure all of the information is correct.
Email address *
FIRST NAME *
Name you would like on Name Tag, and seat card
Your answer
LAST NAME *
Your answer
GRADE *
YEARS ATTENDING YOUTH AND GOVERNMENT *
GENDER *
Your answer
SCHOOL OR YMCA YOU WILL REPRESENT *
Your answer
YOUR CELL PHONE
Not required we will only use to contact you via text or call pertaining to Youth and Government
Your answer
MEDICATION OR MEDICAL INFORMATION WE SHOULD KNOW ABOUT
Your answer
DIETARY INFORMATION *
Do you have any special dietary needs we should alert the cafeteria staff to.
Committee Preference # 1 *
We will use this to get you assigned to a committee you are interested in, you will be assigned to the same committee as your bill, if you write several bills you will be on one of the committees.
Committee Preference # 2 *
We will use this to get you assigned to a committee you are interested in, you will be assigned to the same committee as your bill, if you write several bills you will be on one of the committees.
Committee Preference # 3 *
We will use this to get you assigned to a committee you are interested in, you will be assigned to the same committee as your bill, if you write several bills you will be on one of the committees.
Parents Names *
Your answer
Home Address *
Your answer
Town *
Your answer
Zip Code *
Your answer
Home Phone *
Need this in order to contact in case of emergency
Your answer
I HAVE READ AND AGREE TO ADHERE TO THE YOUTH AND GOVERNMENT CODE OF CONDUCT *
You need to read and understand that we require all participants to adhere to the Code of Conduct, Dress Code, Hotel Policies, and all parts of this agreement.
A copy of your responses will be emailed to the address you provided.
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