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  • Current Youth's Information
  • Authorized Adults for Pick-Up
  • Questions/Comments
  • Authorized Signature
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Youth's Information

Please submit this form once for each of your children that you would like to sign up for Youth Leadership Academy.

This information will be provided to the Y staff who are supervising your child at the school or at the Y.

This form does not guarantee your child's spot in YLA. (Your child's spot is reserved for each day that is paid for in advance.)


Youth's Information
Promotional Agreement
The Two Rivers YMCA and its funding partners have my permission to use photographs or videos of my child in YMCA promotional materials.
Internet Usage
I give permission for my child to use the internet under the supervision of the Y staff.
Please list any special needs (health, physical, dietary, educational, behavioral, etc)
Please list any allergies.
Please list all current prescription medications.
Please describe any specific activited to be encouraged or limited by physician's advice.