2023 Hawaii Youth Impact Program Female Registration Form

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 INFORMATION

Name of Youth Participant(Required)

Nickname of Youth Participant

Gender(Required)

Male

Female

Program Interested In(Required)

Email(Required)

Address(Required)

Street Address City ZIP Code

State(Required)

Date of Birth (Required)

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

Does the Youth Participant have knowledge of STEM?(Required)

Yes

Please describe familiarity or interaction with STEM(Required)

Does your child have any medical/physical conditions?(Required)

Is your child currently on medication?(Required)

Does your child have any allergies?(Required)

Please list all medical conditions, allergies and medications(Required)

If none, please write none or n/a

T-Shirt Size(Required)

Shorts Size(Required)

Parent Guardian Information

Name of Parent or Guardian(Required)

Relationship to student(Required)

Cell Phone Number(Required)

Email(Required)

Emergency Contact information

Name(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)

I 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)

I 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)

Entering Parent/Guardian name here authorizes legal representation for youth participation(Required)

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