YMCA

Missouri YMCA Youth In Government: Student Registration Form

The Student Registration Form must be completed by September 30, 2009.
  • All students must complete the Student Registration Form to participate in the YIG Model Government Program.
  • If you have any questions about or trouble with the form, please contact Ken Hussey at khussey@jcymca.org.
  • You must be in a delegation and complete all required fields to register for the program.
  • You also must turn in the Student Participation Agreement and Medical Form to your delegation director.
  • Please note that this form works best when JavaScript is enabled.

Student Information
Please enter the following information to register for YIG. Your PREFERRED NAME will be used on your nametag at the State Convention.

Prior YIG Participant?
  
Name (First, Preferred, Last):
   
Example:
Abraham, Abe, Lincoln
Sex:
  
Date of Birth:
  (Example: 06/25/2003)
High School Grad Year:
      T-Shirt Size:
Delegation:
   If not listed, please contact the YIG State Office.

Contact Information
Please enter accurate information so YIG can keep in contact with you about the program.

Address:
     
Home Phone:
    Cell Phone:
Can YIG send you text messages?
  
Email:

Parent/Guardian Information
Please enter emergency contact information for you.

Name:
Relationship to you:
Home Phone:
  Cell Phone:   Work Phone:
Email:
----------------------------------------------------------------------------------------------------------------------------------------------------
Name:
Relationship to you:
Home Phone:
  Cell Phone:   Work Phone:
Email:

Program Area
Please select your Program Area. A new box will appear below with questions specific to your Program Area. Please answer all questions.

Program Area:


Running for Office
Are you currently a junior, with one year of experience in YIG? If so, you are eligible to run for office. If you are interested in running for office, please select which one below. This does not register you officially to run for this office. It simply provides the State Office with your indication of interest in running for office.

Office:

Terms of Agreement
Please review the following statement and indicate your agreement.

I have reviewed the Student Participation Agreement. I agree to abide by all the rules and requirements set forth by Missouri YMCA Youth In Government.





Home   -   Contact Us   -  Forms & Applications   -  Key Dates & Deadlines   -  Program Documents