2024 Arizona Youth Impact Program for Boys Registration

In addition to the registration form below, please download the Arizona Youth Impact Program Waiver Forms after registration. You can email completed forms to info@youthimpactprogram.org or bring them in person to the draft night.

2024 ARIZONA YIP REGISTRATION FORM FOR BOYS

Please use this form to register for the 2024 Boys Arizona Youth Impact Program at the University of Arizona June 17-28 (Monday - Friday - no program on June 19)

YOUTH INFORMATION

First Name of Youth Participant(Required)

Last 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 Level as of Fall 2024(Required)

School(Required)

School District(Required)

Height(Required)

Weight (in lbs)(Required)

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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