2020 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
LAST NAME *
GRADE *
YEARS ATTENDING YOUTH AND GOVERNMENT *
GENDER *
SCHOOL OR YMCA YOU WILL REPRESENT *
YOUR CELL PHONE
Not required we will only use to contact you via text or call pertaining to Youth and Government
MEDICATION OR MEDICAL INFORMATION WE SHOULD KNOW ABOUT
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 *
Home Address *
Town *
Zip Code *
Home Phone *
Need this in order to contact in case of emergency
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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