Join Youth Initiative! - Nazareth Academy

Application for Youth Initiative
Name: _________________________________Year of Graduation:_______________
Address: ____________________________________Homeroom: ________________
City
_______________________________Zip Code ______T-Shirt Size _________
Home telephone: _____________Email:______________________________________
Cell Phone: __________________Do you check your email account regularly [ ] yes [ ] no?
Elementary School you attended: ___________________________________________
Please list any activities you are currently involved in at school and in the community:
Why do you want to be involved in the Youth Initiative?
I will attend the training on Sunday, June 3 rd from 1:00 PM to 5:00 PM at Library at
Nazareth. I agree to attend the monthly meetings of the Youth Initiative and to
participate in the activities of the project.
_______________________________________________
(Signature of Student)
(Date)
I ____________________grant permission for my son/daughter __________________
to attend the leader training for the Nazareth Youth Initiative on, Sunday, June 3 rd from
1:00 PM to 5:00 PM in the Library at Nazareth.
I grant permission for my son/daughter to participate in the activities of the program.
_______________________________________________
(Signature of Parent)
(Date)
Please return this form to Cathy Kokontis’ mailbox by May 25.