Youth and Government Club Interest Form
Contact Information
First Name
Last Name
Contact Email
Contact Number
Grade
School Information
Full School Name
Please include the full name for your school, not an abbreviated version. For example, if you go to Austin High School, you would write Stephen F. Austin High School.
School City
Do you have a Club Sponsor/Advisor?
Yes
No
Sponsor/Advisor Email
How did you hear about us?
YMCA Branch
School Staff Member
Student/Peer
Social Media
Website
Other
Please explain if other:
Student Name
Staff Name
Contact Information