2023 HAWAII YIP FEMALE REGISTRATION FORM Please use this form to register for the 2023 Hawaii Youth Impact Program at the University of Hawai'i Mānoa July 6-15 (no program on July 9) YOUTH INFORMATIONName of Youth Participant(Required) Nickname of Youth Participant Gender(Required) Male Female Program Interested In(Required)Please Select OneUniversity of HawaiiUniversity of ArizonaAlexandria Program ( Male and Female Programs Available )University of MichiganEmail(Required) Address(Required) Street Address City ZIP Code State(Required)Please select your stateAlabama (AL)Alaska (AK)Arizona (AZ)Arkansas (AR)California (CA)Colorado (CO)Connecticut (CT)Delaware (DE)District of Columbia (DC)Florida (FL)Georgia (GA)Hawaii (HI)Idaho (ID)Illinois (IL)Indiana (IN)Iowa (IA)Kansas (KS)Kentucky (KY)Louisiana (LA)Maine (ME)Maryland (MD)Massachusetts (MA)Michigan (MI)Minnesota (MN)Mississippi (MS)Missouri (MO)Montana (MT)Nebraska (NE)Nevada (NV)New Hampshire (NH)New Jersey (NJ)New Mexico (NM)New York (NY)North Carolina (NC)North Dakota (ND)Ohio (OH)Oklahoma (OK)Oregon (OR)Pennsylvania (PA)Puerto Rico (PR)Rhode Island (RI)South Carolina (SC)South Dakota (SD)Tennessee (TN)Texas (TX)Utah (UT)Vermont (VT)Virginia (VA)Virgin Islands (VI)Washington (WA)West Virginia (WV)Wisconsin (WI)Wyoming (WY)Armed Forces AmericasArmed Forces EuropeArmed Forces PacificDate of Birth - must be mm/dd/yyyy format(Required) MM slash DD slash YYYY Grade as of Fall 2023(Required) School(Required) School District(Required) Height(Required) Weight (in lbs)(Required)Is the youth participant of Hawaiian decent? Yes No Does the Youth Participant have knowledge of STEM?(Required) Yes No Please describe familiarity or interaction with STEM(Required) Does your child have any medical/physical conditions?(Required)SelectYesNoIs your child currently on medication?(Required)SelectYesNoDoes your child have any allergies?(Required)SelectYesNoPlease list all medical conditions, allergies and medications(Required) If none, please write none or n/aT-Shirt Size(Required)SelectYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLShorts Size(Required)SelectYouth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XLParent Guardian InformationName of Parent or Guardian(Required) Relationship to student(Required) Cell Phone Number(Required)Email(Required) Emergency Contact informationName(Required) Relationship to Student(Required) Cell Phone Number(Required)Statement of Responsibility:I, the Legal Guardian, understand that in completing this application, I support my child in participating in this academic and athletic program(Required)SelectYesNoI will not schedule vacation time or admit my child into other camps during the program dates, otherwise I forfeit their spot as to allow another camper to attend(Required)SelectYesNoI assume FULL risk and responsibility for their commitment and participation in this program and I agree to waive any claims against the YIP and the Host Organization(Required)SelectYesNoEntering Parent/Guardian name here authorizes legal representation for youth participation(Required) Hiddensource