HPAC Youth Development Programs Sign Up Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

HPAC Youth Development Programs Sign Up Form

Sign in to Google to save your progress. Learn more

* Indicates required question

Which program are you signing up for? *

Delta Academy (Girls Ages 11-14)

Delta GEMS (Girls Ages 14-18)

E.M.B.O.D.I (Boys Ages 13-17)

Child's Full Name *

Your answer

Child's Grade *

As of fall 2023

Grade 6

Grade 7

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Child's Date of Birth *

MM

/

DD

/

YYYY

Does participant have any food allergies? *

Yes

No

Please specify any food allergies *

Your answer

Parent's Full Name *

Your answer

Parent's Phone Number *

Your answer

Parent's Email Address *

Your answer

Emergency Contact's Full Name *

Your answer

Emergency Contact's Phone Number *

Your answer

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy