ContractProyouth Xl Expanded Learning Program Agreement • April 30th, 2021
Student’s Full Legal Name: 2021/22 Grade: Birth Date: / / Age: School: School ID number: Students 18 years or older may fill out this application for themselves.Gender: Ethnicity/Race: Primary Language: Eligible for free and reduced meals (circle one): Y / N Student Address: City: Zip: Parent/Guardian: Relationship: Parent/Guardian: Relationship: Phone #: ( ) - Release Authorization (circle one): Y / N Phone #: ( ) - Release Authorization (circle one): Y / NEmail: Email: Copies of any custody agreements, court orders, and restraining orders pertaining to the student? (circle one): Y / NParent/Guardian must keep the school and ProYouth updated with legal documents.Emergency Contacts:Name: Phone#: ( ) - Relationship: Name: Phone#: ( ) - Relationship:
ContractProyouth Xl Expanded Learning Program Agreement • October 12th, 2020
Student’s Full Legal Name: 2020/21 Grade: Birth Date: / / Age: School: School ID number: Students 18 years or older may fill out this application for themselves.Gender: Ethnicity/Race: Primary Language: Eligible for free and reduced meals (circle one):YYe/sN Student Address: City: Zip: Parent/Guardian: Relationship: Parent/Guardian: Relationship: Phone #: ( ) - Release Authorization (circle one): YYe/ sN Phone #: ( ) - Release Authorization (circle one): YYe/sNEmail: Email: Copies of any custody agreements, court orders, and restraining orders pertaining to the student? (circle one): YYe/ sN Parent/Guardian must keep the school and ProYouth updated with legal documents.Emergency Contacts:Name: Phone#: ( ) - Relationship: Name: Phone#: ( ) - Relationship:
