Jóvenes en Acción Application If you are having issues submitting this application, please email info@hydesquare.org or call 617-524-8303.What session are you applying for?* Summer (July - August) Fall (September - December) Winter (January - March) Spring (March - June) If you were to rank your preferred art discipline, which would be your first choice?* DANCE MUSIC THEATRE Please select only one. If you were to rank your preferred art discipline, which would be your second choice?* DANCE MUSIC THEATRE Please select only one. If you were to rank your preferred art discipline, which would be your third choice?* DANCE MUSIC THEATRE Please select only one. How did you find out about our program?*Music Clubhouse (MCH)Dance/Theatre at HenniganSocial MediaSchool PresentationFlyerSchool Field Trip to HSTFTeacherFriendOpportunity FairViva EventOtherHSTF Community EventDance/Theatre at Margarita Muniz AcademyFamily MemberOther: Participant InformationName:* First Last Date of Birth:* Month Day Year Age* Gender:* Female Male Non-Binary Gender Questioning Gender Transitioning Other If other, please specify:* Address:* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home Phone Number:*Youth Cell Phone Number (if available):*Youth Email Address:* Which of the following best describes you? Please choose one answer:* Asian or Pacific Islander Black or African American Hispanic or Latino Native American or Alaskan Native White or Caucasian Multiracial or biracial A race/ethnicity not listed here If other, please specify:* Country of Origin*BrazilCape VerdeColombiaCosta RicaCubaDominican RepublicEcuadorEl SalvadorGuatemalaHaitiHondurasJamaicaMexicoOtherPanamaPeruPuerto RicoUnited States of AmericaVenezuelaWhat school do you currently attend?* Academy of the Pacific Rim Boston Arts Academy Boston Collegiate Boston Community Leadership Academy Boston Green Academy Boston International School Boston Latin Academy Boston Latin School Boston Preparatory Boston Teachers Union K-8 School Boston Trinity Academy Brighton High Brooke 8th Grade Academy Brooke High Burke High Charlestown High City on a Hill City on a Hill (Dudley) Codman Academy Conservatory Lab Cristo Rey Boston Curley K-8 Dearborn STEM Academy East Boston High Edison K-8 English High Excel Academy Excel High Fenway High Henderson K-12 Inclusion Hennigan K-8 Hernandez K-8 Irving Middle Joseph Lee Kennedy Academy for Health Careers 11-12 Kennedy Academy for Health Careers 9-10 Madison Park Marblehead Margarita Muniz Academy MATCH High MATCH Middle McCormack Middle Meridian Academy Mission Hill K-8 Murphy K-8 Newcomers Academy New Mission High O'Bryant Quincy Upper School Roxbury Preparatory Sharon Snowden International Tecca Online School TechBoston Academy Timilty Middle Tobin K-8 UP Academy Dorchester Urban Science Academy Young Achievers Science & Math K-8 Other Another Course to College English High School Boston Adult Technical Academy Charlestown High School Edward M. Kennedy Academy for Health Careers Brook Farm Business Academy Parkway Academy Dorchester Academy West Roxbury Academy Greater Egleston High School Community Academy of Science & Health Boston Day & Evening Academy McKinley South End Academy If you selected "other" above, please write in the name of your school below. What grade are you in?9th10th11th12th8thParent / Guardian InformationParent / Guardian Name:* First and Last Relationship to Youth:* Address*Street City, State, ZIP CodeHome Phone Number:*Cell Phone Number:*Email Address:* Parent/Guardian Country of Origin*BrazilCape VerdeColombiaCosta RicaCubaDominican RepublicEcuadorEl SalvadorGuatemalaHaitiHondurasJamaicaMexicoOtherPanamaPeruPuerto RicoUnited States of AmericaVenezuelaConsent You have my consent.The information provided on this form is true and accurate to the best of my knowledge and I give permission for my son/daughter to participate in Hyde Square Task Force programs and activities.Parent / Guardian Signature:* Participant Signature:* Date:* MM slash DD slash YYYY Δ
