Liberty Youth Council Registration
Event Timing: 2019 - 2020
Event Address: Liberty Town Hall - 239 S Fayetteville St. Liberty, 27298
Contact us at 336.880.0537 cell or
Email address *
Student Name (First and Last) *
Your answer
Student Email *
Your answer
School Name *
Parent's Names (Primary Parent or both) *
Your answer
Parent's Contact Information (email or Cell) for Permission *
Your answer
Student's Birthdate *
Student's T-Shirt Size (Adult Sizes)
Current Grade Point Average (2018-2019 school year) *
Your answer
Liberty Youth Council Terms & Conditions *
I have read the terms and conditions of the Liberty Youth Council and agree to abide by it. I understand that the Liberty Youth Council will require my participation in meetings, trainings, and service learning activities. I understand that if I am granted into the Liberty Youth Council I will have to complete at least 30 community service hours. I understand if I am accepted into Liberty Youth Council, I will be held to higher standard as a role model for my school, peers and community. Upon any instance, in which I use poor judgment, which violates standard Code of Conduct, I will be removed from the Liberty Youth Council immediately. By answering 'Yes' below I am committing to abiding by the Code of Conduct and by-laws set by the Council and its Advisors.
Liberty Youth Council Video/Photo Consent *
I give full video and photo consent to the Liberty Youth Council to use for Council publicity.
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