2022 State YMCA Youth and Government Participant Application
Welcome to the STATE YMCA OF MAINE'S YOUTH AND GOVERNMENT PROGRAM.                                                            
Help us develop a list of interested students so we can stay in contact with you as plans come together for our Spring 2022 conference.  
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Email *
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
Parents Names *
Home Address *
Town *
Zip Code *
Home Phone *
Need this in order to contact in case of emergency
What Committee Would you like to be on choice 1 *
What Committee Would you like to be on choice 2 *
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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