Jóvenes en Acción Application | Hyde Square Task Force

Art Discipline Selection

If you were to rank your preferred art discipline, which would be your first choice?*

DANCE
MUSIC
THEATRE

If you were to rank your preferred art discipline, which would be your second choice?*

DANCE
MUSIC
THEATRE

If you were to rank your preferred art discipline, which would be your third choice?*

DANCE
MUSIC
THEATRE

Participant Information

Name:*

First Last

Date of Birth:*

MM

DD

YYYY

Age:*

Gender:*

Male
Female
Other

Address:*

Street Address City State / Province / Region ZIP / Postal Code

Home Phone Number:*

Cell Phone Number:*

Email Address:*

Race (Check all that apply):*

Black
White
Latino
Asian
Other

Ethnicity:*

Country of Birth:*

What school do you currently attend?*

What grade are you in?*

Parent / Guardian Information

Parent / Guardian Name:*

First Last

Relationship to youth:*

Address:*

Street Address City State / Province / Region ZIP / Postal Code

Home Phone Number:*

Cell Phone Number:*

Email Address:*

Parent / Guardian Country of Birth:*

Communication*

Hyde Square Task Force (HSTF) uses Remind (a communication platform) as a way to connect with youth and their families. Remind is a free service that lets HSTF send quick messages via text, push notifications, or email to everyone involved with Jóvenes en Acción. We’ll be able to stay in touch without revealing our personal contact information. By submitting this application, you agree to be contacted by staff via Remind.

You have my consent

Parent/Guardian Signature:*

Participant Signature:*

Date*

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.

You have my consent

Parent/Guardian Signature:*

Participant Signature:*

Date*