Summer Camp Registration

Youth Application
- This form is not accepting responses at this time.
  
  Please complete the following information for each child you would like to register for the
  2025 Ryves Youth Center Summer Camp - Serving Up Values.
  
  I give my child permission to participate in Ryves Youth Center Summer Camp from June 3- August 8, 2025. Please select this field.
  
  Parent or Guardian's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parent or Guardian's Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Home Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Sex (M/F) REQUIRED Male Female Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Race REQUIRED Please fill out this field. Please enter valid data.
  
  School REQUIRED Please fill out this field. Please enter valid data.
  
  Grade Completed in Spring 2025 REQUIRED Please fill out this field. Please enter valid data.
  
  Medical Needs (disabilities, allergies, etc.) REQUIRED Please fill out this field. Please enter valid data.
  
  EMERGENCY CONTACTS
  Please list 2 people we can call in case of Emergency.
  
  Contact Name 1 REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  Contact Name 2 REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  If your child is expelled or the Youth Center closes early, what should we do? (Ex: Call parent, walk home, ride with another family, etc.) REQUIRED Please fill out this field.
  
  FIELD TRIPS
  Children must come to camp regularly to go on field trips.
  
  TEEN MENTORS
  
  Please choose the appropriate response below: REQUIRED My child is in 8th-12th grade and would like to be a youth mentor. My child is in 8th-12th grade and would like to be a camper. Not applicable Please fill out this field.
  
  TIME FOR ME MENTORING
  
  If you would also like your 8-17 year old child to be eligible to participate in the TIME for Me Mentoring program, check the box below. REQUIRED
  If you check "Yes" our Mentoring Coordinator will contact you for more information.
  Yes, I give my child permission to participate in TIME for Me: Trauma Informed Care Mentoring Program. No Please fill out this field.
  
  ADDITIONAL DOCUMENTS
  Waiver of Responsibility, Membership Rules for Ryves Youth Center and Photo Consent forms must be completed before or on the first day of Summer Camp. Please request these forms from Melissa Schneider or click on the form names above to download, print and complete these forms.
  
  Submit
  
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Summer Camp Registration

EMERGENCY CONTACTS

FIELD TRIPS

TEEN MENTORS

TIME FOR ME MENTORING

ADDITIONAL DOCUMENTS