Ekam USA Youth Ambassador Form

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Please fill the form with the youth ambassador and parent details. At least one parent participation is mandatory.

Email *

Option 1

Clear selection

First Name (Youth Ambassador) *

Last Name (Youth Ambassador) *

Age *

Grade *

Youth Ambassador Email - Note: This email id will be used if EYA needs Journyz login created (to record hours). *

Youth Ambassador Phone (enter 111-111-1111 if you don't have a phone) Needed for communications at chapter level *

Parent First Name (Parent that will be involved in Ekam activities with EYA- parental involvement is needed to support the coordinators) *

Parent Last Name *

Parent Phone (111-111-1111) *

Parent Email *

Parent Profession

IT Professional

Physician

Finance

Business

Option 5

Other:

Clear selection

Parent Employer Name (Company) (for information about matching grants for donations etc. from employers) *

City *

State *

Select a Chapter *

Citizenship - Youth Ambassador (To determine eligibility for President's Volunteer Service Award) *

US Citizen

Permanent Resident

Other:

Role(s) Youth Ambassador is interested in

Volunteer at Community Activities and Events

Help with fundraising activities

Help with membership drives

Other:

NOTE: All volunteers can participate in Ekam Programs and Activities and are eligible for a service hours certificate and for President's Volunteer Service Award (depending on qualification criteria). To receive a letter of recommendation, EYA must demonstrate commitment to the program throughu 25 or more service hours and 4 main volunteering events in a year

WAIVER: In consideration of Ekam USA allowing me/my child/my organization/my family to participate in volunteering opportunities and being aware of the possible injuries or harm that could occur as a result of this participation, I, on behalf of myself, my child, my organization, my family, release Ekam USA, its volunteers, employees, agents, instructors, from any and all injuries and damages whatsoever arising from participation in events

Waiver *

I agree (Parent)

Required

CONTENT: I permit Ekam USA to use photos, audio, video, etc of me/my child/my family participating at volunteering and other events in any marketing materials, on website, social media, etc . I agree to receive emails from Ekam USA about activities, youth opportunities, and newsletters.

Permission *

I agree (Parent)

Required

Please add eya@ekamusa.org and youth@ekamusa.org to your email address book otherwise you may miss emails from us with important information about projects and workshops

EYA Membership Donation $250 https://www.paypal.com/donate?hosted_button_id=L44D2LQ4BPCEY

A copy of your responses will be emailed to the address you provided.

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